J Korean Assoc Oral Maxillofac Surg.  2024 Feb;50(1):41-48. 10.5125/jkaoms.2024.50.1.41.

Ultrasound-guided intraoral botulinum toxin injection into the lateral pterygoid muscle for chronic temporomandibular joint dislocation

• Lee ST
• Kim D
• Park JH
• Kwon TG

• KMID: 2553661
• DOI: http://doi.org/10.5125/jkaoms.2024.50.1.41

Abstract

Objectives
Botulinum toxin type A (BTX), a powerful neurotoxin, can be an effective treatment choice for diverse muscular disorders and can reduce abnormal muscle activities. Abnormal movements of the mandible can be caused by involuntary and uncontrolled contractions of the lateral pterygoid muscle (LP) in various pathological situations. Previous reports have shown that BTX can reduce abnormal contractions of the LP. However, needle placement into the LP for BTX injection requires skill, experience, and sufficient anatomical knowledge. To place the needle precisely into the LP, ultrasonography (USG) can be used as an effective needle-guidance modality. USG is a non-invasive imaging modality able to create real-time images without any potential risks, including radiation exposure. Patients and Methods: The patients who had been performed USG-guided BTX injection into the LP using an intraoral approach were included in this study with a literature review and case presentations. Using the USG, four patients received BTX injections to treat recurrent temporomandibular dislocation and oromandibular dystonia resulting from involuntary LP activity. Result: Involuntary movements of the mandible were improved successfully in all patients, and showed satisfactory results without significant complication.
Conclusion
The intraoral approach could prevent potential complications during needle placement. USG-guided BTX injection is an effective, con-venient, and safe method that provides real-time imaging without unnecessary pain to the patient.

Keyword

Botulinum toxin type A; Temporomandibular joint disorders; Ultrasonography; Pterygoid muscles

Figure

• 

  Fig. 1 Ultrasonography (USG)-guided intraoral botulinum toxin type A (BTX) injection in the lateral pterygoid muscle (LP). A. Injection of BTX in the LP via the intraoral approach, with placement of the ultrasound probe on the extraoral side. B. The BTX injection needle was advanced lateral to the maxillary tuberosity, directed toward the neck of the condyle. C. A skull model demonstrates the needle entry point into the LP. D. USG image of BTX injection into the LP. The broken arrow indicates the coronoid process (hyper-echoic), whereas the short arrow indicates a needle inserted into the LP.

• 

  Fig. 2 A. An 82-year-old female patient with recurrent bilateral temporomandibular joint (TMJ) dislocation. B. After injection of botulinum toxin type A (15 units/side) into the lateral pterygoid muscle, no further recurrence of TMJ dislocation was noted for up to 12 months.

• 

  Fig. 3 A. A 56-year-old female patient with involuntary mouth opening, involuntary closing of the right eye, and pain on mouth opening in the right temporomandibular joint. After botulinum toxin type A (BTX) injections into bilateral lateral pterygoid muscles (LPs) (25 units/side) and the anterior belly of digastric muscles (10 units/side) under ultrasonography guidance, her involuntary mouth opening was alleviated. Upon recurrence, additional BTX injection was performed into bilateral LPs and digastric muscles. B. After 6 months, involuntary mouth opening resolved, with no complications or discomfort.

Reference

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