J Korean Assoc Oral Maxillofac Surg.  2013 Aug;39(4):188-192.

Correction of post-traumatic anterior open bite by injection of botulinum toxin type A into the anterior belly of the digastric muscle: case report

• Seok H
• Park YT
• Kim SG
• Park YW

Abstract

Post-traumatic anterior open bite can occur as a result of broken balance among the masticatory muscles. The superior hyoid muscle group retracts the mandible downward and contributes to the anterior open bite. Denervation of the digastric muscle by injection of botulinum toxin type A (BTX-A) can reduce the power of the digastric muscle and help to resolve the post-traumatic anterior open bite. A patient with a bilateral angle fracture had an anterior open bite even after undergoing three operations under general anesthesia and rubber traction. Although the open bite showed some improvement by the repeated operation, the occlusion was still unstable six weeks after the initial treatment. To eliminate the residual anterior open bite, BTX-A was injected into the anterior belly of the digastric muscle. Following injection of BTX-A, the anterior open bite showed immediate improvement. Complication and relapse were not observed during follow-up. Long-standing post-traumatic open bite could be successfully corrected by injection of BTX-A into the anterior belly of the digastric muscle without complication.

Keyword

Open bite; Neck muscles; Botulinum toxins

MeSH Terms

Anesthesia, General
Botulinum Toxins
Botulinum Toxins, Type A
Denervation
Follow-Up Studies
Humans
Mandible
Masticatory Muscles
Muscles
Neck Muscles
Open Bite
Recurrence
Rubber
Traction
Botulinum Toxins
Botulinum Toxins, Type A
Rubber

Figure

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  Fig. 1 The patient already received open reduction operation 2 times in another hospital. Pre-operative three-dimension computed tomography image of the left mandibular angle area. Anterior open-bite and a large bony gap (arrow) were shown.

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  Fig. 2 First day after the third operation. A. Lateral view. B. Panoramic view.

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  Fig. 3 Injection sites of botulinum toxin type A in the anterior belly of digastric muscles (arrows).

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  Fig. 4 Third day after botulinum toxin type A injection. A. Lateral view. B. Panoramic view.

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  Fig. 5 Post-operative three-dimension computed tomography image of left mandibular angle area in 4 weeks after botulinum toxin type A injection. The gap between fragments was healed (arrow) and the occlusion was stable.

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