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. 2024 Aug 16;16(8):364.
doi: 10.3390/toxins16080364.

Intramuscular Botulinum Toxin as an Adjunct to Arthrocentesis with Viscosupplementation in Temporomandibular Disorders: A Proof-of-Concept Case-Control Investigation

Luca Guarda Nardini  1 , Daniele Manfredini  2 , Anna Colonna  2 , Edoardo Ferrari Cagidiaco  2 , Marco Ferrari  2 , Matteo Val  2
Affiliations

Intramuscular Botulinum Toxin as an Adjunct to Arthrocentesis with Viscosupplementation in Temporomandibular Disorders: A Proof-of-Concept Case-Control Investigation

Luca Guarda Nardini et al. Toxins (Basel). .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: arthrocentesis; botulinum toxin; hyaluronic acid; orofacial pain; osteoarthritis; temporomandibular disorders; temporomandibular joint.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Variations in pain at rest (score according to VAS scale) in T0 (before treatment), T1, T2, T3, T4, and T5 (2 months after last arthrocentesis in T4) in Group A.
Figure 2
Figure 2
Variations in pain at rest (score according to VAS scale) in T0 (before treatment), T1, T2, T3, T4, and T5 (2 months after last arthrocentesis in T4) in Group B.
Figure 3
Figure 3
Variations in pain during chewing (score according to VAS scale) in T0 (before treatment), T1, T2, T3, T4, and T5 (2 months after last arthrocentesis in T4) in Group A.
Figure 4
Figure 4
Variations in pain during chewing (score according to VAS scale) in T0 (before treatment), T1, T2, T3, T4, and T5 (2 months after last arthrocentesis in T4) in Group B.
Figure 5
Figure 5
Mastication efficiency variations (score according to VAS scale) in T0 (before treatment), T1, T2, T3, T4, and T5 (2 months after last arthrocentesis in T4) in Group A.
Figure 6
Figure 6
Mastication efficiency variations (score according to VAS scale) in T0 (before treatment), T1, T2, T3, T4, and T5 (2 months after last arthrocentesis in T4) in Group B.
Figure 7
Figure 7
Functional limitation variations (0, absent; 1, slight; 2, moderate; 3, intense; 4, severe) in T0 (before treatment), T1, T2, T3, T4, and T5 (2 months after last arthrocentesis in T4) in Group A.
Figure 8
Figure 8
Functional limitation variations (0, absent; 1, slight; 2, moderate; 3, intense; 4, severe) in T0 (before treatment), T1, T2, T3, T4, and T5 (2 months after last arthrocentesis in T4) in Group B.
Figure 9
Figure 9
Site of injection of BTX in masseter and temporalis muscle. The dots indicate the injection sites for BTX, while the lines outline the recommended areas for injecting the masseter muscle inferiorly and the anterior portion of the temporalis muscle superiorly.
See this image and copyright information in PMC

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