Outcome of Treatment With Botulinum toxinA in Patients With Temporomandibular Myofascial Pain

Outcome of Treatment With Botulinum toxinA in Patients With Temporomandibular Myofascial Pain

Purpose: The aim of this study is to investigate the effectiveness and patient reported outcomes (interincisal distance and temporomandibular myofascial pain) of treatment with intramuscularly administered BTX-A vs N/S in patients with temporomandibular myofascial pain. OBJECTIVES: To determine the outcome of treatment with botulinum toxin-A vs N/S in patients with temporomandibular myofascial pain.

OPERATIONAL DEFINITIONS:

Temporomandibular myofascial pain: Presence of any one or more of the following plus positives:

Pain in the Jaw Muscles: Persistent or recurrent pain located in the muscles of mastication (muscles that move the jaw).

Tenderness on Palpation: The pain is associated with tenderness that is identified during palpation of the affected muscles, particularly in the masseter, temporalis.

Limited Range of Motion: Patients often exhibit a reduced range of motion in the jaw.

OUTCOMES:

Temporomandibular myofascial pain score: Pain score will be assessed before and after 4, 8, and 12 weeks using visual analogue scale. It would determine subjective pain experience of patients. Visual Analogue Scale (VAS) represents continuous pain intensity, where the left end of the line indicates "no pain," while the right end denotes "worst pain imaginable." Patients indicates their level of pain (in cm), by marking a single point on the line.

Interincisal Distance: The interincisal distance refers to the measurement between the edges of the upper and lower central incisors when the jaw is fully opened using vernier caliper and it would be quantified in mm. Normal mouth opening ranges from 40-60 mm, mouth opening less than 40 mm would be consider as trismus.

HYPOTHESIS:

Botulinum toxin-A injection of 10-100 units would reduce the pain and increase the interincisal distance in patients with TMJ-MFP.

Inclusion Criteria:

• Patients presenting with temporomandibular myofascial pain (VAS ≥ 6) for more than one month will be included.
• Both genders.
• Age 18-70 years

Exclusion Criteria:

• Patient with history of allergic reactions with botulinum toxin-A.
• Medically compromised patients. Current pregnancy.
• Use of medication by the patients that could interfere with the effect of botulinum toxin-A (gentamycin, baclofen, atropine, revastigmine, verapamil, succinylcholine)
• Neuromuscular disorders.