Effect of Botulinum Toxin Injection on EMG Activity and Bite Force in Masticatory Muscle Disorder: A Randomized Clinical Trial

Abstract

Botulinum toxin type A (BoNT-A) is increasingly used in treating masticatory muscle pain disorder; however, safe doses and reinjection intervals still need to be established. The purpose of this randomized clinical trial was to evaluate the degree and duration of the impairment of masticatory muscle performance. Fifty-seven subjects were randomly divided into two groups: one of which received BoNT-A first (n = 28) while the other received saline first (n = 29), with the cross-over being in week 16, and a total follow-up period of 32 weeks. A total dose of 50 U of BoNT-A was injected in the masseter and temporal muscles bilaterally. Electromyographic (EMG) activity and bite forces were assessed. A significant reduction in EMG activity was observed up to week 18 (p ≤ 001), with total recovery at week 33. A significant reduction in maximum bite force was observed up to week 11 (p ≤ 005), with total recovery at week 25. In conclusion, when treating masticatory muscle pain disorder with 50 U of BoNT-A, a reinjection interval of 33 weeks can be considered safe since the recovery of muscle function occurs by that time.

Keywords: botulinum toxin type A; chronic pain; masticatory muscle disorder; myofascial pain; temporomandibular disorders.

Figure 1

CONSORT diagram for participant enrollment.

Figure 2

Box plots of the average electromyography (EMG) values of the masseter muscle after botulinum toxin and saline injections. The BS group (a) botulinum toxin injected at the baseline and saline at the 16-week follow-up; the SB group (b) saline injected at the baseline and botulinum toxin at the 16-week follow-up. The week calculated from the second injection is marked in brackets. For each box plot, maximum and minimum, 25th and 75th percentiles, median (solid line inside the box), mean (cross inside the box), and outliers (dots) are presented.

Figure 3

Regression lines for EMG (a) and bite force (b) mean values after botulinum toxin injection. BS group: botulinum toxin injected at the baseline and saline at the 16-week follow-up.

Figure 3

Regression lines for EMG (a) and bite force (b) mean values after botulinum toxin injection. BS group: botulinum toxin injected at the baseline and saline at the 16-week follow-up.

Figure 4

Box plots of bite force values after botulinum toxin and saline injections. BS group (a) botulinum toxin injected at the baseline and saline at the 16-week follow-up; SB group (b) saline injected at the baseline and botulinum toxin at the 16-week follow-up. The week calculated from the second injection is marked in brackets. For each box plot, maximum and minimum, 25th and 75th percentiles, median (solid line inside the box), mean (cross inside the box), and outliers (dots) are presented.