Sowmya Ananthan

Background: The twin block Injection is a novel nerve block that has been shown previously to be efficacious in the management of masticatory myofascial pain. Little is known about its effectiveness for reducing pain from the temporomandibular joint (TMJ). Case report: A 19-year-old man presented with limited mouth opening with pain in the left side of his face. After a thorough history and examination was completed, the diagnosis was acute anterior disc displacement without reduction in the left TMJ and myalgia of the left side temporalis and masseter muscles. After receiving the twin block injection, the patient reported that the pain in his TMJ had reduced along with the concomitant myalgia. The twin block injection is efficacious for the management of both arthrogenous and myogenous sources of temporomandibular disorders.

Masticatory myofascial pain is the one of the most common etiologies for nonodontogenic pain, often characterized by the presence of trigger points. Conventional management includes approaches such as jaw exercises, physical therapy, intraoral appliances, medications, and trigger point injections. Peripheral/regional nerve blocks have shown to be effective in managing myogenous pain conditions. The twin block is a nerve block that blocks both the masseteric and the anterior deep temporal nerves. The objective of this case series is to illustrate expeditious and sustained efficacy of the twin block in the management of chronic masticatory myofascial pain.

Objective: To compare the efficacy of a regional masseteric nerve block (MNB) in the management of myofascial pain of masseteric origin, relative to trigger point injection (TrP-Inj) and intra-oral stabilization appliance (IOA). Study design: A retrospective chart review of 200 patients treated for myofascial pain of masseteric origin was performed. Sixty patients met the eligibility criteria and were grouped based on their treatment regimen; IOA, TrP-Inj or MNB. Pain scores recorded at pre-treatment (baseline), 30 minutes post-treatment, and 2 weeks post-treatment were analyzed. Results: Treatment with MNB resulted in significant reduction in pain at 30 minutes and two weeks post-treatment compared to TrP-Inj and IOA. Conclusion: MNB provided an immediate and sustained therapeutic effect for the management of myofascial pain for at least up to two weeks. MNB is a simple and valuable tool in the management of myogenous pain, especially for the non-orofacial pain practitioner.

Burning mouth syndrome (BMS) is a chronic pain condition. It has been described by the International Headache Society as "an intra-oral burning or dysesthetic sensation, recurring daily for more than 2 h/day for more than 3 months, without clinically evident causative lesions." BMS is frequently seen in women in the peri-menopausal and menopausal age group in an average female/male ratio of 7:1. The site most commonly affected is the anterior two-thirds of the tongue. The patient may also report taste alterations and oral dryness along with the burning. The etiopathogenesis is complex and is not well-comprehended. The more accepted theories point toward a neuropathic etiology, but the gustatory system has also been implicated in this condition. BMS is frequently mismanaged, partly because it is not well-known among healthcare providers. Diagnosis of BMS is made after other local and systemic causes of burning have been ruled out as then; the oral burning is the disease itself. The management of BMS still remains a challenge. Benzodiazepines have been used in clinical practice as the first-line medication in the pharmacological management of BMS. Nonpharmacological management includes cognitive behavioral therapy and complementary and alternative medicine (CAM). The aim of this review is to familiarize healthcare providers with the diagnosis, pathogenesis, and general characteristics of primary BMS while updating them with the current treatment options to better manage this group of patients.