The effects of botulinum toxin A injection on the lateral pterygoid muscle in patients with a painful temporomandibular joint click: a randomized clinical trial study

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Abstract
Background: Temporomandibular disorder (TMD) is the main cause of non-dental pain in orofacial area. The most common symptoms of TMD are joint pain, joint sound and limitation of jaw function. Botulinum toxin (BTX) injection is considered a potential treatment for TMD due to its pain-relieving properties and its ability to reduce muscle activity. Most of the studies are case series and further investigations are required to prove the efficacy of this treatment modality. Thus, in this study, we aimed to investigate the effect of BTX-A injection on the lateral pterygoid (LP) muscle and to evaluate its efficacy regarding TMD.Materials and methods: Thirty-eight patients (19 women and 19 men; mean age of 26.53 years) with painful unilateral temporomandibular joint click and LP muscle tenderness were enrolled in this study. They were divided into two groups; one received an extraoral BTX-A injection in the LP muscle, and the other received a placebo injection. Pain severity, jaw movements, click severity, and Helkimo index were recorded at the first visit, as well as one week, one month, and three months after the intervention. Data were analyzed using repeated-measures analysis of variance andt-tests.Results: The results showed that click severity was not significantly different between the BTX-A and placebo groups (P = 0.07). Pain and Helkimo index decreased significantly in the BTX group (P = 0.00 andP = 0.006, respectively); however, there was no significant difference between the two groups (P = 0.22 andP = 1, respectively). There was a significant difference in lateral movements between the groups (P = 0.00) but not in protrusive movement (P = 0.095).Conclusions: It can be concluded that although some studies have stated that BTX injection can make the click sound disappear, in this study, we did not find a significant difference between the two groups. Furthermore, our results showed that click and pain severity decreased, but the difference was not statistically significant. Therefore, further studies with a higher dosage of BTX and more participants are recommended.Trial registrationThe local Ethics Committee of Shiraz University of Medical Sciences approved this research (IR.SUMS.REC. 01/10/2018 and IRCT20130521013406N3).

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