ABSTRACT Objective The Unified Spasmodic Dysphonia Rating Scale (USDRS) was developed in 1997 to standardize evaluation of adductor‐type laryngeal dystonia (AdLD) but has been sparsely utilized since then. The goal of this study was to explore the descriptive value and contemporary relevance of the USDRS in characterizing AdLD by examining its relationships with established patient‐reported, clinician‐perceptual, and acoustic measures. Methods Patients with stable‐dose, botulinum toxin‐A (BtxA)‐responsive AdLD presented to a tertiary laryngology center for follow‐up BtxA injections. USDRS, PROMs (Voice Handicap Index‐10, Dyspnea Index, OMNI‐Vocal Effort Scale, and Communicative Participation Item Bank‐10), and voice recordings were obtained. Acoustic analysis was completed, and voice‐specialized speech‐language pathologists blindly rated voices using the Consensus Auditory Perceptual Evaluation–Voice (CAPE‐V). Descriptive statistics compared each measurement with USDRS results. Results Forty‐four patients (mean age 58.4 years) were evaluated in this study. The USDRS demonstrated significantly lower variance than all other clinician‐ and patient‐reported outcomes as well as acoustic analysis. Comparison of overall USDRS score to other outcome measures demonstrated statistically significant, positive correlations: USDRS versus VHI‐10 ( R = 0.451, p = 0.002), Overall Severity ( R = 0.482, p = 0.004), and Strain ( R = 0.487, p = 0.004), respectively. Conclusions The USDRS exhibited restricted variability relative to VHI‐10, CAPE‐V, and CPP‐S and did not appear to add information beyond these measures; therefore, it may be limited for monitoring treatment response in AdLD patients. Level of Evidence 4.

Can inter-sphincteric and pelvic floor botulinum toxin type A injections enhance clinical outcomes in pediatric patients with non-neurogenic dysfunctional voiding?

Synkinesis is a sequela of moderate to severe facial palsy, caused by aberrant nerve regeneration. It leads to involuntary co-movements, impaired facial expression, and thus reduced quality of life. Treatment includes facial therapy, EMG biofeedback, botulinum toxin (BTX-A), and, in selected cases, surgery. This case report presents a case from Rigshospitalet demonstrating symptom relief and improved facial symmetry after treatment with BTX-A injections and facial therapy. Synkinesis is a complex condition that requires a multidisciplinary approach. Early detection, prevention and appropriate referral are crucial.

Botulinum toxin A (BtxA) injection for AdLD is typically performed approxiamately every 3 months. DaxibotulinumtoxinA-lanm (Daxi) is a peptide-formulated neuromodulator with reported longer therapeutic duration. This study compared the safety and efficacy of Daxi to historical BtxA results in AdLD patients. In this open-label, prospective clinical trial, 22 stable-dose, BtxA-responsive AdLD patients underwent Daxi injection. To optimize safety, the first 10 patients' doses were given in a staged fashion (3-6 days between half doses). Safety and duration of voice benefit (DVB) were the primary outcomes. PROMs and voice analyses were obtained pre- and monthly post-injection. Of 22 patients, 20 (75% female, mean age = 58.3) were analyzed, with two excluded for injection "misses." No adverse reactions were reported. EAT-10 showed no difference pre- and post-Daxi injection (p = 0.068). VHI-10 significantly improved (p = 0.004) pre- to post-injection. Procedural LEMG quantitative data for Daxi and BtxA were comparable (p = 0.279). DVB of Daxi was longer than BtxA in 8/20 (40%), equal to BtxA in 7/20 (35%), and shorter than BtxA in 5/19 (25%). Those with Daxi benefit had on average 43.9% (39.5 days) longer therapeutic duration than previous BtxA treatments. Seven patients (35%) returned to BtxA at subsequent injection whereas 13 patients (65%) desired repeat Daxi injection. This study represents the first implementation of Daxi for AdLD. Daxi was notably safe and effective. Although no overall significant difference was noted for the entire study cohort, 40% of patients reported substantially longer duration of voice benefit with Daxi than with BtxA, with 43.9% longer duration than their previous BtxA treatments.

Introduction BTX-A has been used in the management of spasticity in CP for >25 years in NZ and is provided by different specialists in centres across NZ. The aims of this study were to (1) describe use of BTX-A interventions for children with CP across NZ at a population level; (2) explore inequities of access. Methods Data from the NZ Cerebral Palsy Register, matched with Ministry of Health data were analysed by GMFCS level, CP type, ethnicity, NZ Deprivation Index, and region. Analysis included 1,149 children across NZ. Results By age 15, 725 children (63%) had ≥1 episodes of BTX-A injections (total: 3,732 episodes). By regression modelling, for GMFCS levels, compared to GMFCS I the odds of having any BTX-A were all increased in levels II- IV, with a peak at level III (OR: GMFCS II 3.05; III 5.41; IV 4.85). When adjusted by GMFCS levels, those with a diagnosis of triplegia or quadriplegia, were less likely to have BTX-A than those with hemiplegia or diplegia (OR: 0.38). Compared to Starship, other regions had a 25-35% lower chance of repeat injection episodes. However, region did not affect age at first treatment. Socioeconomic status and ethnicity were not statistically associated with odds of BTX-A treatment, age at first treatment, or treatment frequency. Discussion/Conclusions Two in three children with CP had BTX-A injections in childhood; these children were more likely to be GMFCS levels III and IV and classified as hemiplegia / diplegia. The region of service showed the largest degree of variation in the delivery of repeat injections, with Starship delivering greater number of repeat episodes compared to other centres in NZ. Inequities related to socio-economic status and ethnicity were not seen.

To investigate ocular surface dysfunction in patients with benign essential blepharospasm (BEB) by evaluating lid wiper epitheliopathy (LWE) and ocular surface parameters and to compare these findings with those of normal and dry eye controls. Additionally, we aimed to assess the impact of botulinum toxin (BTX-A) injection on ocular surface parameters and LWE. This study included BEB patients and age- and sex-matched healthy and dry-eye controls. LWE grading and ocular surface parameters were assessed, including OSDI score, Schirmer's I test, tear break-up time (TBUT), corneal staining, eyelid margin abnormalities, and meibomian gland function. Patients with BEB received BTX-A injections, and measurements were repeated 1, 3, and 6months post-treatment. Compared to control groups, the BEB group exhibited significantly increased OSDI scores, corneal surface staining, eyelid margin abnormalities, meibomian expression, meibography scores, meibomian gland loss, and LWE grades of the upper and lower eyelid (p < 0.05) while TBUT and Schirmer's I test values were significantly decreased (p < 0.05). Significant positive correlations were observed between the severity and frequency of BEB and ocular surface dysfunction, including LWE (p < 0.05). LWE severity was significantly correlated with age, female gender, and ocular surface parameters (p < 0.05). BTX-A injection significantly improved ocular surface parameters for 6months, but LWE reduction was insignificant at 6months (p < 0.05). LWE was identified as a significant contributor to conjunctivocorneal damage in BEB. Furthermore, BTX-A injection effectively treats ocular surface dysfunction, including LWE.

Objective: The objective of this study was to clarify the connection between BTX-A injections and local changes in skin temperature and to assess the correlation between post-BTX-A injection facial vascular hyperthermia and subcutaneous adipose tissue thickness (SAT) in the frontal area using thermography. Methods: The study involved 30 patients (mean age 42 ± 0.5 years; 18 women, 12 men). Facial skin temperature was measured via thermography (Thermo GEAR G30) before, immediately after, and 20 min after subcutaneous injection of BTX-A with hemagglutinin complex, gelatin (6 mg), and maltose monohydrate (12 mg). SAT development was graded by combined visual-palpation assessment. Statistical analysis included Student's t-test and the Mann-Whitney U-test. Results: Biphasic thermal response: immediately post-injection: Significant decrease in min (-1.1 °C) and mean (-0.3 °C) facial temperatures (p < 0.05); 20 min post-injection: pronounced increase in mean (+1.5 °C), max (+1.3 °C), and min (+1.6 °C) temperatures (p < 0.001), attributed to BTX-A-induced vasodilation and local inflammation. Subjects with pronounced SAT exhibited significantly higher baseline temperatures (Me = 33.1 °C vs. 29.8 °C; p < 0.001) and more intense hyperthermic responses (+1.6 °C mean increase vs. +1.1 °C in low-SAT group; p < 0.001). Pronounced SAT was predominantly female (10/15; p < 0.05) and linked to higher BMI (33.3% overweight vs. 0% in low-SAT; *p = 0.036*). Conclusions: SAT thickness is a key determinant of post-BTX-A vascular hyperthermia, with pronounced SAT predicting stronger reactions. Practical Recommendation: Targeted local hypothermia (+4 °C to +8 °C for 5-7 min post-injection, adjustable by SAT thickness) mitigates hyperemia, edema, hematoma risk, and potential toxin diffusion, especially in high-SAT individuals.

Preoperative intramuscular botulinum Toxin-A to enhance postoperative outcomes in oral submucous fibrosis surgery: A randomized controlled trial.

OnabotulinumtoxinA (BTX-A) decreases urge urinary incontinence (UUI) and improves quality of life for patients with idiopathic overactive bladder (IOAB) and neurogenic lower urinary tract dysfunction (NLUTD). Limited research exists optimizing injection techniques for higher doses (200- or 300-units) of BTX-A in the clinic setting. Optimization with less injections could improve satisfaction and willingness to repeat injections while maintaining effectiveness. This is a prospective, single-blinded, parallel randomized controlled trial of patients undergoing higher doses of BTX-A for treatment of refractory IOAB or NLUTD in the office setting. Patients were randomized to either 5- or 20-injections. The primary outcome was patients' willingness to repeat the procedure. Secondary outcomes included pain, symptomatology, and adverse events (AEs) assessments. For N = 78 participants (N = 39 per arm), no difference was seen in patients' willingness to repeat the procedure between the 5- or 20-injection groups before and after injection (Mean difference = 0.18, p = 0.57) or at 6-8 week follow-up (Mean difference = 0.06, p = 0.83). There was a significant increase in immediate post-procedural pain after 20 (M = 3.39, SD 3.01) compared to five injections (M = 0.57, SD = 2.07) (Mean difference = 2.83, p > 0.00002). N = 55/78 (71%) completed follow-up. N = 16 experienced AEs (N = 8/26 for 5-injections, N = 7/29 for 20-injections). Despite a significant increase in pain for patients with NLUTD and IOAB receiving 20 injections compared to 5, patients in both groups were equally willing to repeat BTX-A injections. There were no significant differences in AEs or secondary outcomes. This suggests decreasing the number of injections from 20 to 5 will improve pain scores when higher doses of BTX-A are used in the office setting with affecting efficacy. NCT06059066.

Vesicoureteral reflux (VUR) management in children with neurogenic bladder dysfunction (NBD) remains a clinical challenge. Total endoscopic management (TEM), combining intradetrusor Onabotulinum Toxin-A (BTX-A) and subureteric dextranomer/hyaluronic acid (Deflux(R)) injection, offers a minimally invasive alternative. The aim of this retrospective study is to evaluate the long-term effectiveness of TEM. Inclusion criteria: symptomatic II–V grade VUR (also I in bilateral VUR) in NBD children with follow-up ≥12 months. Nineteen patients were enrolled, 24 ureters (grade I–II: 2, grade III–V: 22); 5 patients (20.8%) had bilateral VUR. Mean age at surgery: 7.6 years (1.3–17). No complications were reported. TEM was effective in 11 patients (57.9%), 3/11 requiring a second TEM treatment. VUR resolution appeared in 14 ureters (58.3%), downgrading in 6 (42.9%), persistence in 4 (28.6%). Among non-responders’ patients (8/19, 42.1%), five (26.3%) required bladder augmentation (one combined with ureteral reimplantation), one (5.3%) underwent reimplantation, and two (10.5%) continued conservative management. At bladder biopsy, 11 patients (57.9%) had chronic inflammation, 8 (42.1%) showed fibrosis; no difference in success rate was recorded. All responders required repeated BTX-A injections. Mean follow-up: 3.2 years (range 1–4.7). In selected patients, TEM appears to be a safe and effective strategy, potentially delaying or avoiding major reconstructive surgery.

ObjectiveTo perform a quantitative and qualitative analysis of spin bias in randomized clinical trials (RCTs) focusing on botulinum toxin (BTX-A) for managing bruxism.Study design and protocolThis is a meta-epidemiologic study. The protocol was registered on the Open Science Framework.Study selectionWe included RCTs that evaluated the effectiveness of BTX-A for managing bruxism, associated or not with signs and symptoms of temporomandibular disorders. The outcomes were changes in pain and bruxism events. Spin bias was investigated in abstract and main text. The frequency of spin bias was assessed, and a qualitative analysis was conducted. The study was classified as effective if the outcome analyzed was statistically significant (p-value 0.05) and reached the minimum important difference of 20% and ineffective if the reported outcome was statistically nonsignificant or the study did not report the p-value or the results did not reach the minimum important difference of 20%.ResultsAn overall frequency of 59.4% spin bias was identified in eight included RCTs. The conclusion in the main text (87.5%) was the section with the highest frequency of spin bias. In the qualitative analysis, the most common strategies identified were inadequate extrapolation to a large population (30.61%), inadequate implication for clinical practice (20.41%), and misleading reporting (12.25%).ConclusionThere is a high frequency of spin bias in RCTs that evaluated BTX-A for bruxism management. Close to 90% of the selected RCTs presented spin bias in the main text’s conclusion. The most common spin was the inadequate extrapolation of the results.Clinical SignificanceApplying BTX into the temporalis did not reduce muscle activity and the results for masseter injections remain controversial. It seems that BTX-A injections can reduce pain from two weeks to one year. It is not possible to have certainty about the efficacy and safety of using BTX-A to reduce pain and bruxism events.

While botulinum toxin injections (BTX-A) have been long used to treat myofascial pain (MFP) in the neck and shoulder region, the evidence of its effectiveness remained unclear. Thus, we aimed to examine the existing evidence on the efficacy of BTX-A injections for reducing MFP in the neck and shoulder areas. This was a systematic review of Medline, Embase, Cinahl, Scopus, and Central databases. Only randomized controlled trials were included. Random effects meta-analysis with effect size index as weighted mean difference (WMD) was applied. The search resulted in 100 records, of them seven were considered relevant and included in the meta-analysis. In total, the data from 261 patients were analyzed. Five trials focused on entire neck/upper back and shoulder pain, one on the infraspinatus muscle and one on the trapezius muscle. The dose of BTX-A varied from 20 to 400 UI. The risk of systematic bias was high for three trials and low for four trials. The pooled WMD was statistically significant [-10.22 (95% confidence interval (CI) -12.77 to -7.68)] on a scale from 0 to 100 in favor of BTX-A over sham. However, the difference was not clinically significant. Also, the meta-regression coefficient was insignificant [-0.01 (95% CI -0.04 to 0.02)]. The overall quality of evidence was moderate. In conclusion, there is moderate evidence that BTX-A injections are not more effective than saline injections to treat MFP in the neck and shoulder region. The effect of BTX-A did not exceed the level of clinical significance. So far, BTX-A cannot be recommended for clinical use when dealing with MFP in the neck and shoulder.

Onabotulinum toxin A (BTXA) is an effective treatment for refractory idiopathic overactive bladder (iOAB). Given the wide spectrum of patient factors and combination of symptoms, a tailored approach to management is needed. This scoping review assesses injection paradigms for iOAB. Prior studies have established the safety and efficacy of BTXA injections, and this review focuses on exploring variations in injection techniques that may inform more tailored approaches and support future research toward optimizing patient outcomes. We conducted a systematic literature search. Inclusion criteria included full-text English language and primary research studies assessing outcomes in adults undergoing BTXA for iOAB. Findings are summarized using narrative synthesis. Forty-three articles were identified. Key findings include fewer injections (1-10 vs. 20-40) maintains efficacy while reducing procedure time, discomfort, and retreatment hesitancy. Durability appears to be lower with suburothelial and bladder base injections and higher with detrusor and bladder body injections, though these may carry an increased risk of urinary retention requiring clean intermittent catheterization. Trigone inclusion appears safe and effective without increased vesicoureteral reflux risk. Study heterogeneity and inconsistent reporting limit strong conclusions. Included injection paradigms demonstrated efficacy, high tolerability, symptom relief, and quality-of-life improvements with few adverse events. Further research is needed to refine optimal injection strategies to enhance patient comfort, maximize efficacy, and minimize adverse events. Future studies should ensure comprehensive data collection to clarify these associations.

Background: Spasticity is a muscle stiffness issue often caused by spinal cord or cerebral diseases, notably impairing stroke patients. This study aims to evaluate the long-term effectiveness of repeated Botulinum Toxin A injections on spasticity and arm function, to understand if the treatment's effects accumulate or diminish over time. Methods: This study examines 85 stroke patients treated with one or five sessions of BTX-A injections between 2013 and 2019. Patients were divided into two groups based on the number of sessions and evaluated using Modified Ashworth Scores, Brunnstrom Stage, and Frenchay Arm Test. Results: This study includes 85 hemiplegic patients with an average age of around 50, and various muscle groups were treated with BTX-A injections. Group 2, who received five sessions, showed significantly greater improvement in MAS scores for certain muscle groups and had higher FAT scores compared to Group 1, who received just one session. Overall, BTX-A treatment led to significant improvements in MAS, Brunnstrom, and FAT scores across all patients. Conclusions: Our findings corroborate existing literature by affirming that Botox injections effectively mitigate spasticity and enhance arm functionality. Notably, our data reveal that repeated Botox treatments yield significantly greater benefits in reducing spasticity in the elbow pronators, wrists, and finger flexors compared to a single session. This study uniquely demonstrates the cumulative benefits of multiple BTX-A sessions, highlighting that repeated applications not only sustain but also amplify functional improvements over time. These results advocate for the feasibility and augmented effectiveness of administering a series of five Botox injections in the management of post-stroke spasticity.

Onabotulinumtoxin A (BTX-A) is a minimally invasive therapy for idiopathic overactive bladder (iOAB). Incomplete bladder emptying is a known risk of the procedure, with an overall rate as high as 20% in male and female patients. Risk factors for incomplete bladder emptying after BTX-A have been reported in the literature, but are widely variable amongst studies and therefore patients at increased risk of this adverse effect cannot easily be identified by clinicians. The aim of this study was to evaluate whether pre-procedure urodynamics (UDS) findings are associated with incomplete bladder emptying after intradetrusor BTX-A injection for iOAB. Data were analyzed from the SUFU Research Network (SURN) multi-institutional retrospective database. Men and women undergoing first-time injection of 100 units BTX-A for iOAB in 2016 were included. Subjects were excluded if they did not have record of pre-procedure and post-procedure (within 1 month) post-void residual volume (PVR). The primary outcome was incidence of urinary retention within 1 month after BTX-A, defined as PVR > 300 mL and/or initiation of self-catheterization or indwelling catheter. We assessed the association of pre-procedure UDS parameters with urinary retention using Wilcoxon rank tests, Fisher's exact test, and chi-squared tests. A total of 167 subjects (141 women, 26 men) were included. Ninety-nine subjects (59%) had urodynamic data. Thirty-seven subjects (22%) had urinary retention within 1 month of BTX-A. There were no significant differences in age, gender, race, or body mass index between the retention and non-retention groups. There was no statistically significant difference in median Qmax between those who did and did not have postprocedure retention (10.0 vs. 14.3 mL/s respectively, p = 0.06). Mean PVR at the start of UDS was not statistically significant when comparing the retention and non-retention groups (22.5 vs. 10.0 mL respectively, p = 0.70). Bladder outlet obstruction index (BOOI), bladder contractility index (BCI), and presence of detrusor overactivity (DO) were not found to be associated with posttreatment retention. This retrospective multi-institutional cohort study revealed that of patients who receive UDS before BTX-A, there are no significant UDS parameters or baseline demographic factors associated with incomplete bladder emptying after intradetrusor BTX-A injections for iOAB. Future studies that focus on better defining objective evidence-based predictors of incomplete emptying after BTX are needed to optimize patient perception of efficacy and satisfaction with this therapy.

Urinary tract infection (UTI) is the most common complication of intradetrusor onabotulinumtoxinA (BTX-A) injection. Despite this, there are no evidence-based guidelines on antibiotic prophylaxis. Our primary aim was to determine whether antibiotic prophylaxis decreased symptomatic, culture-proven UTI rates within 6 weeks of intradetrusor BTX-A injection. Our secondary aims were to determine if there are differences between antibiotic regimens and to identify risk factors for developing a UTI. This was a prospective, observational multicenter cohort study of female patients receiving BTX-A for idiopathic overactive bladder. We compared patients who received antibiotics (nitrofurantoin or trimethoprim-sulfamethoxazole) to those who did not. To detect a 15% difference in UTI rates between groups (80% power, alpha = 0.05), 270 participants were needed. A total of 282 participants ultimately received BTX-A and were included in the analysis. One hundred eighty-one (62.6%) were in the antibiotic cohort and 101 (35.8%) were in the no-antibiotic cohort. The overall rate of symptomatic, culture-proven UTI was 12.1%, and there was no difference between the antibiotic and no-antibiotic cohort (10.6% vs 14.9%, respectively; P = 0.29). On multivariable logistic regression, UTI was associated with older age (adjusted odds ratio [aOR], 1.07; 95% CI, 1.02-1.11), BTX-A dose of 200 units (aOR, 4.24; 95% CI, 1.45-12.35), and self-catheterization (aOR, 26.0; 95% CI, 3.62-186.5). The odds of symptomatic UTI were lower among postmenopausal participants (aOR, 0.13; 95% CI, 0.02-0.68) and participants in the Northeast United States (aOR, 0.23; 95% CI, 0.08-0.72). Our study did not find a lower rate of symptomatic, culture-proven UTI among participants who took antibiotics compared with those who did not.

This systemic review with meta-analysis evaluated the effect of intranasal BTX-A turbinate injection on chronic rhinitis-related symptoms. PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases. We reviewed studies retrieved from databases up to Aug 2024. The studies evaluating the degree of change of rhinitis-related symptom scores and quality of life before and after BTX-A injection were analyzed. Standard mean differences were used to calculate effect sizes. A total of 269 patients from 7 studies were analyzed. BTX-A injection showed a significant improvement in rhinitis-related symptoms (congestion: 2.5416, 95% CI 1.0927-3.9905, I2 = 94.4%, itching: 1.2553, 95% CI 0.6660-1.8446; I2 = 70.8%, rhinorrhea: 1.8451, 95% CI 1.0468-2.6435, I2 = 89.7%, and sneezing: 1.3580, 95% CI 0.5194-2.1967; I2 = 90.7%), total nasal symptom score (2.4020, 95% CI 1.4161-3.3879, I2 = 86.1%), and quality of life (1.5256, 95% CI 1.0760-1.9752; I2 = 0.0%) throughout the follow-up period (4 months). However, 3 months after injection, although symptom improvement remained, there was no statistical significance. Allergic rhinitis (AR) patients showed a significant improvement in rhinitis-related symptoms compared with nonallergic rhinitis (NAR) patients. Nasal symptoms and quality of life scores related to rhinitis were decreased after BTX-A injection. In particular, this treatment showed better efficacy in AR and could be more beneficial for the symptoms of nasal congestion and rhinorrhea at the early periods of treatment. However, the effects lasted for a relatively short period of only 2-3 months. Laryngoscope, 135:1545-1552, 2025.

Intradetrusor OnabotulinumtoxinA outcomes for overactive bladder in older adults

It is important to distinguish spasticity from contracture in patients presenting with upper motor neuron (UMN) syndrome and restricted range of movement (ROM) because treatment strategies differ. We demonstrate how we perform ultrasound-guided obturator nerve (ON) block to distinguish spasticity from contracture in a patient with bilateral hip adductor spasticity secondary to a non-traumatic spinal cord injury. We report here a 26-year-old gentleman with a history of Mycobacterium tuberculosis thoracic spondylodiscitis with spinal cord compression. His neurological status was T6 ASIA impairment scale C and his impairments were spastic paraparesis, neurogenic bowel and neurogenic bladder. He had difficulty with wheelchair transfer and positioning, perineal care as well as intermittent self- catheterization due to severe spasticity of bilateral hip adductors with significantly restricted ROM. Bilateral ON block resulted in clinically significant improvement in spasticity and ROM of the right lower limb but not the left. The effects were similar following intramuscular BTX-A injection of bilateral hip adductors. Ultrasound-guided diagnostic ON block via the distal approach is inexpensive, safe and can be readily performed in clinic setting without the need for sedation or prolonged monitoring. Improvement in MAS score of at least 1 point and ROM of at least 15° following ON block should be used to distinguish hip adductor spasticity from contracture in patients with UMN syndrome and reduced ROM. Diagnostic nerve block allows for greater physician certainty when discussing various treatment options including expedited referral for surgical consult. The findings of this report offer insights into the decision-making process in managing complex presentations of UMN syndrome.

The reduction in joint load is a potential beneficial factor in managing osteoarthritis of the temporomandibular joint (TMJ). This paper aims to compare the effectiveness of the intramuscular injection of botulinum toxin (BTX-A) as an adjunct to TMJ arthrocentesis plus viscosupplementation with arthrocentesis plus viscosupplementation alone in the management of TMJ osteoarthritis. A pilot clinical retrospective study examined TMJ osteoarthritis treatments. Patients were divided into two groups: Group A received BTX-A injections and arthrocentesis with viscosupplementation, while Group B received only arthrocentesis with viscosupplementation. The study assessed outcomes based on mouth opening (MO), pain at rest (PR), pain at mastication (PF), and masticatory efficiency (ME) at various time points (baseline (T0), 1 week (T1), 2 weeks (T2), 3 weeks (T3), and 4 weeks (T4)) up to 2 months after treatment. The study included two groups, each with five patients. Group A received five weekly sessions of arthrocentesis plus viscosupplementation and a single BTX-A injection during the first arthrocentesis appointment. Group B underwent the five-session protocol of arthrocentesis plus viscosupplementation alone. MO, PF, PR, and ME improved quickly in T2 in both groups, but the improvement was of greater importance over the following weeks and lasted longer in Group A. Arthrocentesis with viscosupplementation associated with BTX-A was found to be more effective than arthrocentesis alone in improving clinical outcomes. This suggests that patients with TMJ osteoarthritis and myofascial pain may benefit from reduced muscle tone and joint load.