Determination of optimal points for botulinum toxin injections in the treatment of patients with temporomandibular myofascial pain syndrome

To understand the processes occurring during the development of temporomandibular myofascial pain syndrome, a clear description of the anatomical components is necessary. In the literature, the term «stomatognathic system» is used for this, the elements of which are the temporomandibular joint, masticatory muscles and the dental periodontal complex. Each component of the system is influenced by a number of factors, primarily psychological, which causes the subjectivization of clinical manifestations from headaches to pathological tooth cutting and the development of temporomandibular joint dysfunction. One of the methods of treating this pathology is to inject botulinum toxin type A into the chewing muscles. However, the question of the choice of methods of administration of botulinum toxin and its dosage remains relevant.

Materials and methods. Botulinum toxin injections were performed outside and intraoral in 30 patients with temporomandibular myofascial pain syndrome. The effectiveness of the therapy was evaluated on the basis of clinical examination data, analysis of the degree of mouth opening before the start of treatment, after 14 days, 6 and 12 months.

Results. The high efficiency of botulinum toxin type A injections in the treatment of the above pathology has been proven.

Conclusion. It is important to evaluate the effectiveness of treatment based on the developed clinical examination methods, if necessary, correct it in a timely manner at all stages of treatment and follow-up of patients with temporomandibular myofascial pain syndrome.

1. Moola S., Munn Z., Tufanaru C., Aromataris E., Sears K., Sfetcu R., Currie M., Lisy K., Qureshi R., Mattis P., et al. Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E., Munn Z., editors. JBI Manual for Evidence Synthesis. JBI; Miami, FL, USA: 2020. https://www.sciepub.com/reference/324238.

2. Hu S., Shao Z., Deng L. Clinical manifestations, imaging features, and pathogenic/ prognostic risk factors for temporomandibular disorders (TMD): a case-control study based on psychogenic factors of patients. Computational and Mathematical Methods in Medicine. 2022;25 https://www.researchgate.net/publication/362257618_Clinical_Manifestations_Imaging_Features_and_PathogenicPrognostic_Risk_Factors_for_Temporomandibular_Disorders_TMD_A_Case-Control_Study_Based_on_Psychogenic_Factors_of_Patients.

3. Makedonova Yu. A., Vorobyov A. A., Alexandrov A.V., Dyachenko D. Yu. Screening diagnostics of masticatory muscle hypertension in adults // Certificate of registration of the database No. 2021621703 dated 08/11/2021, application No. 2021621557 dated 07/29/2021 https://www.elibrary.ru/item.asp?id=46471398.

4. Rongo R., Ekberg E.C., Nilsson I.M., Michelotti A. Diagnostic criteria for temporomandibular disorders (DC/TMD) for children and adolescents: an international delphi study – Part 1-development of axis I. Journal of Oral Rehabilitation. 2021;48:836–845. https://pubmed.ncbi.nlm.nih.gov/33817818/.

5. Kopacz Ł., Ciosek Ż., Gronwald H., Skomro P., Ardan R., Lietz-Kijak D. Comparative analysis of the influence of selected physical factors on the level of pain in the course of temporomandibular joint disorders. Pain Research and Management. 2020(2):45–52. https://pubmed.ncbi.nlm.nih.gov/33101559/.

6. Urbański P., Trybulec B., Pihut M. The application of manual techniques in masticatory muscles relaxation as adjunctive therapy in the treatment of temporomandibular joint disorders. International Journal of Environmental Research and Public Health. 2021;18(24). https://pubmed.ncbi.nlm.nih.gov/34948580/.

7. Trezubov V.N., Bulycheva E.A., Trezubov V.V., Bulycheva D.S. Treatment of patients with disorders of the temporomandibular joint and masticatory muscles: clinical recommendations. – Moscow: GEOTAR-Media, 2021. – 96 p.

8. Osiewicz M., Lobbezoo F., Ciapała B., Pytko-Polończyk J., Manfredini D. Pain Predictors in a Population of Temporomandibular Disorders Patients. J. Clin. Med. 2020;9:452. https://pubmed.ncbi.nlm.nih.gov/32041274/.

9. Andre A., Kang J., Dym H. Pharmacologic treatment for temporomandibular and temporomandibular joint disorders. Oral and Maxillofacial Surgery Clinics of North America. 2022;34(1):49–59. https://pubmed.ncbi.nlm.nih.gov/34598856/

10. Manfredini D. Temporomandibular disorders: modern concepts of diagnosis and treatment / Daniele Manfredini. – 2013 – 972 p . https://emll.ru/find-?iddb=17&ID=RUCML-BIBL-0001407716.

11. Makedonova Yu.A., Yarygina E.N., Alexandrov A.V., Chizhikova T.V., Dyachenko Yu.A., Filimonova O.N. Gradation of the severity of hypertonus of the masticatory muscles. Endodontics Today. 2024;22(1):80–85. https://doi.org/10.36377/ET-0006.

12. Simoen L., Van den Berghe L., Jacquet W., Marks L. Depression and Anxiety Levels in Patients with Temporomandibular Disorders: Comparison with the General Population. Clin. Oral Investig. 2020;24:3939–3945. https://pubmed.ncbi.nlm.nih.gov/32219566/.

13. Makedonova Yu.A., Vorobyov A. A., Osyko A. N., Alexandrov A.V., Pavlova-Adamovich A. G., Gatsenko S. M. Comparative analysis of the effectiveness of me thods for relieving masticatory muscle hypertension in children with cerebral palsy // Periodontology. – 2022. – 27(4). – pp. 295-303. https://doi.org/10.33925/1683-3759-2022-27-4-000-000.

14. An integrated approach to the treatment of neuromuscular TMJ syndrome. Clinical observation / I.V. Petrikas, A.P., Kurochkin, D.V. Trapeznikov, etc. // Problems of dentistry. – 2018. – pp. 66–70. https://cyberleninka.ru/article/n/kompleksnyy-podhod-k-lecheniyu-neyromuskulyarnogo-disfunktsionalnogo-sindroma-vnchs-k-linicheskoe-nablyudenie.

15. Canales G.D.L.T., Guarda-Nardini L., Rizzatti-Barbosa C.M., Conti P.C.R., Manfredini D. Distribution of Depression, Somatization and Pain-Related Impairment in Patients with Chronic Temporomandibular Disorders. J. Appl. Oral Sci. 2019;27:e20180210. https://pubmed.ncbi.nlm.nih.gov/30624469/.

16. Soyher S.M. Dysfunction of the masticatory muscles: anatomical foundations in etiopathogenesis / S.M. Soyher, V.A. Kudryashova, M.V. Oganesyan, N.A. Rizaeva // Morphology – science and practical medicine. 2018. pp. 331–336. https://elibrary.ru/item.asp?edn=xvumyx&ysclid=m411a19t1y849999350.

17. Soyher S.M. Dysfunction of the masticatory muscles: anatomical foundations in etiopathogenesis / S.M. Soyher, V.A. Kudryashova, M.V. Oganesyan, N.A. Rizaeva // Morphology – science and practical medicine. 2018. pp. 331–336. https://elibrary.ru/item.asp?edn=xvumyx&ysclid=m411a19t1y849999350.

18. Soyher M.I. Bruxism: methods of application and results of treatment with botulinum neuroprotein (Relatox) / M.I. Soyher, O.R. Orlova, M.G. Soyher // Neuromuscular diseases. – 2019. – pp. 12–20. https://cyberleninka.ru/article/n/bruksizm-metodika-primeneniya-i-rezultaty-lecheniya-botulinicheskim-neyroproteinom-relatoks?ysclid=m411c6vgxe610232161.