title: Treatment of severe temporomandibular joint clicking with botulinum toxin in the lateral pterygoid muscle in two cases of anterior disc displacement.
abstract: A novel treatment procedure is introduced for severe clicking of the temporomandibular joint (TMJ) associated with anterior disc displacement (ADD), using injections with botulinum toxin (BTX-A) in the lateral pterygoid muscle (LP). It has been suggested that ADD may be caused, precipitated, or maintained by LP activity, but the role of the LP in the dynamics of the TMJ clicking is uncertain. The case report includes 2 women, followed with clinical examinations, TMJ imaging, and electromyography (EMG), in whom local anesthetics in the LP could abolish the clicking for several days. BTX-A block of the LP (30 U Botox, given twice under EMG guidance with 6-month interval) temporarily reduced the action of the muscle, but the clicking was permanently eliminated and did not return during the observation period of 1 year, and a small but distinctive positional improvement in the disc-condyle relationship was obtained. However, the precise mechanisms behind the favourable treatment outcome are unclear.
authors.affiliation: Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, School of Dentistry, University of Copenhagen, Denmark. mb@odont.ku.dk
authors.forename: Merete
authors.initials: M
authors.lastname: Bakke
authors.forename: Eigild
authors.initials: E
authors.lastname: Møller
authors.forename: Lene M
authors.initials: LM
authors.lastname: Werdelin
authors.forename: Torben
authors.initials: T
authors.lastname: Dalager
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Kitai
authors.forename: Sven
authors.initials: S
authors.lastname: Kreiborg
mesh_terms: D000328:Adult; D001314:Auscultation; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004576:Electromyography; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D004204:Joint Dislocations / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011626:Pterygoid Muscles; D016059:Range of Motion, Articular; D013016:Sound; D013705:Temporomandibular Joint Disorders / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A