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

Overview

Journal Toxins (Basel)

Publisher MDPI

Specialty Toxicology

Date 2024 Aug 28

PMID 39195774

Authors

Luca Guarda Nardini

Daniele Manfredini

Anna Colonna

Edoardo Ferrari Cagidiaco

Marco Ferrari

Matteo Val

Affiliations

Soon will be listed here.

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.

References

De la Torre Canales G, Manfredini D, Grillo C, Guarda-Nardini L, Goncalves L, Rizzatti Barbosa C . Therapeutic effectiveness of a combined counseling plus stabilization appliance treatment for myofascial pain of the jaw muscles: A pilot study. Cranio. 2016; 35(3):180-186. DOI: 10.1080/08869634.2016.1168071. View

Colonna A, Guarda-Nardini L, Ferrari M, Manfredini D . COVID-19 pandemic and the psyche, bruxism, temporomandibular disorders triangle. Cranio. 2021; 42(4):429-434. DOI: 10.1080/08869634.2021.1989768. View

Guarda-Nardini L, Masiero S, Marioni G . Conservative treatment of temporomandibular joint osteoarthrosis: intra-articular injection of sodium hyaluronate. J Oral Rehabil. 2005; 32(10):729-34. DOI: 10.1111/j.1365-2842.2005.01505.x. View

Manfredini D, Favero L, Cocilovo F, Monici M, Guarda-Nardini L . A comparison trial between three treatment modalities for the management of myofascial pain of jaw muscles: A preliminary study. Cranio. 2017; 36(5):327-331. DOI: 10.1080/08869634.2017.1349571. View

De la Torre Canales G, Lorenzi Poluha R, Bonjardim L, Ernberg M, Conti P . Botulinum toxin-A effects on pain, somatosensory and psychosocial features of patients with refractory masticatory myofascial pain: a randomized double-blind clinical trial. Sci Rep. 2024; 14(1):4201. PMC: 10879180. DOI: 10.1038/s41598-024-54906-z. View

De la Torre Canales G, Alvarez-Pinzon N, Munoz-Lora V, Peroni L, Farias Gomes A, Sanchez-Ayala A . Efficacy and Safety of Botulinum Toxin Type A on Persistent Myofascial Pain: A Randomized Clinical Trial. Toxins (Basel). 2020; 12(6). PMC: 7354430. DOI: 10.3390/toxins12060395. View

Delcanho R, Val M, Guarda Nardini L, Manfredini D . Botulinum Toxin for Treating Temporomandibular Disorders: What is the Evidence?. J Oral Facial Pain Headache. 2022; 36(1):6-20. PMC: 10586579. DOI: 10.11607/ofph.3023. View

Camara-Souza M, Bracci A, Colonna A, Ferrari M, Rodrigues Garcia R, Manfredini D . Ecological Momentary Assessment of Awake Bruxism Frequency in Patients with Different Temporomandibular Disorders. J Clin Med. 2023; 12(2). PMC: 9862722. DOI: 10.3390/jcm12020501. View

Val M, Delcanho R, Ferrari M, Guarda Nardini L, Manfredini D . Is Botulinum Toxin Effective in Treating Orofacial Neuropathic Pain Disorders? A Systematic Review. Toxins (Basel). 2023; 15(9). PMC: 10535201. DOI: 10.3390/toxins15090541. View

10.

Alpaslan G, Alpaslan C . Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements. J Oral Maxillofac Surg. 2001; 59(6):613-8; discussion 618-9. DOI: 10.1053/joms.2001.23368. View

11.

Gokce Kutuk S, Ozkan Y, Kutuk M, Ozdas T . Comparison of the Efficacies of Dry Needling and Botox Methods in the Treatment of Myofascial Pain Syndrome Affecting the Temporomandibular Joint. J Craniofac Surg. 2019; 30(5):1556-1559. DOI: 10.1097/SCS.0000000000005473. View

12.

Smuts J, Schultz D, Barnard A . Mechanism of action of botulinum toxin type A in migraine prevention: a pilot study. Headache. 2004; 44(8):801-5. DOI: 10.1111/j.1526-4610.2004.04148.x. View

13.

Guarda-Nardini L, Stecco A, Stecco C, Masiero S, Manfredini D . Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. Cranio. 2012; 30(2):95-102. DOI: 10.1179/crn.2012.014. View

14.

Mao T, Wang W . Comparison of outcomes with intra-articular hyaluronic acid vs corticosteroids after TMJ arthrocentesis: a systematic review and meta-analysis. Quintessence Int. 2024; 55(8):660-668. DOI: 10.3290/j.qi.b5586037. View

15.

Grossmann E, Lorenzi Poluha R . Comparative study of arthrocentesis with concentric-needle cannula with classic concentric needle: A randomized single-blind controlled clinical trial. J Craniomaxillofac Surg. 2024; 52(7):850-854. DOI: 10.1016/j.jcms.2024.04.009. View

16.

Sorrenti N, Manfredini D, Sornig F, Ferrari M, Colonna A, Val M . Correlation between bilateral TMJ MRI findings: A systematic review of the literature. Dent Med Probl. 2024; 61(3):401-406. DOI: 10.17219/dmp/184325. View

17.

Valesan L, Da-Cas C, Reus J, Denardin A, Garanhani R, Bonotto D . Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021; 25(2):441-453. DOI: 10.1007/s00784-020-03710-w. View

18.

Rauso R, Giudice G, Tartaro G, Zerbinati N, Nicoletti G, Fragola R . Botulinum toxin type A injections for masticatory muscles hypertrophy: A systematic review. J Craniomaxillofac Surg. 2021; 50(1):7-18. DOI: 10.1016/j.jcms.2021.09.019. View

19.

Guarda-Nardini L, de Almeida A, Manfredini D . Arthrocentesis of the Temporomandibular Joint: Systematic Review and Clinical Implications of Research Findings. J Oral Facial Pain Headache. 2021; 35(1):17-29. DOI: 10.11607/ofph.2606. View

20.

Val M, Sidoti Pinto G, Manini L, Gandolfo S, Pentenero M . Variations of salivary concentration of cytokines and chemokines in presence of oral squamous cell carcinoma. A case-crossover longitudinal prospective study. Cytokine. 2019; 120:62-65. DOI: 10.1016/j.cyto.2019.04.009. View