Intramuscular botulinum toxin injection additional to arthrocentesis in the management of temporomandibular joint pain

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The aim of this study was to compare the effect of intramuscular injection of botulinum toxin (BTX-A) as an adjunct to arthrocentesis with the effect of BTX-A injections alone in the treatment of temporomandibular joint disorders (TMDs) with masticatory muscles tension.

Study Design.

The clinical study included 20 TMD patients divided into 2 groups. The influence of daily activities on pain in the temporomandibular joint (TMJ) area was evaluated in both groups using the rating scale by List and Helkimo. Range of maximal interincisial opening (MIO) and joint pain as measured by the visual analogue scale (VAS) were examined to determine the clinical efficiency of the procedures before and after treatment. Group A consisted of 12 patients; they were treated with arthrocentesis and BTX-A injections in the temporal and masseter muscles. Group B consisted of 8 patients; they had only BTX-A injections in the same muscles as mentioned.


In group A, VAS decreased significantly (P = .005), and MIO improved significantly (P < .005).


Arthrocentesis with BTX-A seems to affect the clinical outcomes with regard to MIO and VAS compared with the results when BTX-A only was used. BTX-A in combination with arthrocentesis improved the TMJ area symptoms.

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