Temporomandibüler eklemin anteriyor disk deplasmanında artroskopiyle beraber kullanılan lateral pterigoid kas botulinum toksin enjeksiyonunun etkisi

Amaç: Bu çalışmada artroskopik lizis, lavaj ve posterior band koterizasyonu yapılan hastalara uygulanan ek lateral pterigoid kası LPK , botulinum toksin-A BTX-A enjeksiyonunun etkisi araştırıldı. Subjektif ve objektif değerler ortaya kondu.Hastalar ve Yöntemler: Çalışmaya 43 hastanın 6 kadın, 37 erkek; ort. yaş 35 yıl; dağılım 15-48 yıl toplam 52 eklemi dahil edildi. Hastalar iki gruba ayrıldı. İlk grup grup 1; n=21 artroskopik lizis, lavaj ve posterior band koterizasyonuyla tedavi edildi. İkinci gruptaki hastalara grup 2; n=22 ise ilk tedaviye ek olarak 20 U LPK BTX-A enjeksiyonu yapıldı. Hastalar birinci hafta ve birinci, üçüncü ve altıncı aylarda olmak üzere lateral deviasyon, protrüzyon ve görsel analog skoru GAS bakımından Student t-testi kullanılarak incelendi.Bulgular: Grup 1 ve grup 2’deki hastalar kendi içlerinde, sadece grup 1 içindeki üçüncü ay sağ deviasyon sonuçları dışında, tedaviye anlamlı yanıt verdi. Her iki grubun karşılaştırılmasında; sadece üçüncü ay sola deviasyon, birinci ay protrüzyon ve en önemlisi birinci aydan itibaren başlamak kaydıyla GAS sonuçları anlamlı bulundu.Sonuç: Lateral pterigoid kasına BTX-A enjeksiyonu yapılan hastalarda birinci aydan başlayarak subjektif skorlarda iyileşme gözlendi. Protrüzyon ve deviasyon gibi diğer değerler genel olarak etkilenmemiş bulundu. Bu bulgular BTX-A enjeksiyonuyla azalan subjektif yakınmaların varlığını ortaya koymaktadır ancak, BTX-A etkisinin zamanla azalması ve toksinin temporomandibüler eklem üzerindeki kesin etki mekanizmasının bilinmemesi nedeniyle bu konuda daha fazla çalışmaya ihtiyaç vardır

Effect of injection of botulinum toxin on lateral pterygoid muscle used together with the arthroscopy in patients with anterior disk displacement of the temporomandibular joint

Objectives: In this study, we aimed to study the effects of an additional lateral pterygoid muscle LPM , botulinum toxin-A BTX-A injection on arthroscopic lysis, lavage and posterior band coagulations. Subjective and objective measures have been documented. Patients and Methods: Fourty three subjects 6 females, 37 males; mean age 35 years; range 15 to 48 years with 52 joints were enrolled in the study. Patients were divided into two groups. The first group was treated with arthroscopic lysis, lavage and posterior band coagulation. The second group received an injection of 20 U of BTX-A to the LPM in addition to the former treatment. Patients were assessed statistically in the first week, and in the first, third and sixth months postoperatively with the measures of lateral deviations, protrusions and visual analogue scale VAS values using Student-t test. Results: Group 1 and group 2 showed significant results within themselves with the exception of the third month values of right deviations in group 1. When groups were compared with each other; significant results were observed in left deviation values only in the third month, protrusion in the first month, and most importantly VAS values starting from the first month. Conclusion: Botulinum toxin-A injection to the LPM mostly improved subjective measures starting from the first month. Other objective measures like protrusions, and deviations were not found to be affected generally. These findings suggest the improvement of symptoms with BTX-A injections in additon to the standard arthroscopy. However, diminishing effect of BTX-A and lack of information on the exact mechanism of action of toxin on temporomandibular joint necessitate further studies on this topic.

___

  • Schwartz M, Freund B. Treatment of temporoman- dibular disorders with botulinum toxin. Clin J Pain 2002;18(6 Suppl):S198-203.
  • McCain JP, Sanders B, Koslin MG, Quinn JH, Peters PB, Indresano AT. Temporomandibular joint arthroscopy: a 6-year multicenter retrospective study of 4,831 joints. J Oral Maxillofac Surg 1992;50:926-30.
  • Miyamoto H, Sakashita H, Miyata M, Goss AN. Arthroscopic surgery of the temporomandibular joint: comparison of two successful techniques. Br J Oral Maxillofac Surg 1999;37:397-400.
  • Murakami K, Hosaka H, Moriya Y, Segami N, Iizuka T. Short-term treatment outcome study for the man- agement of temporomandibular joint closed lock. A comparison of arthrocentesis to nonsurgical therapy and arthroscopic lysis and lavage. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:253-7.
  • Murakami K, Moriya Y, Goto K, Segami N. Four- year follow-up study of temporomandibular joint arthroscopic surgery for advanced stage internal derangements. J Oral Maxillofac Surg 1996;54:285-90.
  • Koslin M. Electrosurgery and laser technology. In: McCain JP, editor. Principles and practice of temporo- mandibular joint arthroscopy. St Louis: Mosby; 1996. p. 24-30.
  • Freund B, Schwartz M, Symington JM. Botulinum toxin: new treatment for temporomandibular disor- ders. Br J Oral Maxillofac Surg 2000;38:466-71.
  • Freund BJ, Schwartz M. Relief of tension-type head- ache symptoms in subjects with temporomandibular disorders treated with botulinum toxin-A. Headache 2002;42:1033-7.
  • Freund BJ, Schwartz M. Intramuscular injection of botulinum toxin as an adjunct to arthrocentesis of the temporomandibular joint: preliminary observations. Br J Oral Maxillofac Surg 2003;41:351-2.
  • Song PC, Schwartz J, Blitzer A. The emerging role of botulinum toxin in the treatment of temporomandibu- lar disorders. Oral Dis 2007;13:253-60.
  • Karacalar A, Yilmaz N, Bilgici A, Baş B, Akan H. Botulinum toxin for the treatment of temporoman- dibular joint disk disfigurement: clinical experience. J Craniofac Surg 2005;16:476-81.
  • Bakke M, Mİller E, Werdelin LM, Dalager T, Kitai N, Kreiborg S. Treatment of severe temporomandibular joint clicking with botulinum toxin in the lateral ptery- goid muscle in two cases of anterior disc displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:693-700.
  • Taskaya-Yilmaz N, Ceylan G, Incesu L, Muglali M. A possible etiology of the internal derangement of the temporomandibular joint based on the MRI observa- tions of the lateral pterygoid muscle. Surg Radiol Anat 2005;27:19-24.
  • Yang X, Pernu H, Pyhtinen J, Tiilikainen PA, Oikarinen KS, Raustia AM. MR abnormalities of the lateral ptery- goid muscle in patients with nonreducing disk dis- placement of the TMJ. Cranio 2002;20:209-21.
  • Zhang L, Sun L, Ma X. A macroscopic and microscopic study of the relationship between the superior lateral pterygoid muscle and the disc of the temporoman- dibular joint. Zhonghua Kou Qiang Yi Xue Za Zhi 1998;33:267-9. [Abstract]
  • Naidoo LC. Lateral pterygoid muscle and its relation- ship to the meniscus of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:4-9.
  • Wongwatana S, Kronman JH, Clark RE, Kabani S, Mehta N. Anatomic basis for disk displacement in tem- poromandibular joint (TMJ) dysfunction. Am J Orthod Dentofacial Orthop 1994;105:257-64.
  • Okeson J, editor. Orofacial pain: guidelines for classifi- cation, assessment, and management. 3rd ed. Chicago: Quintessence Publishing; 1996.
  • Elfving L, Helkimo M, Magnusson T. Prevalence of different temporomandibular joint sounds, with emphasis on disc-displacement, in patients with tem- poromandibular disorders and controls. Swed Dent J 2002;26:9-19.
  • Merrill RG. Historical perspectives and comparisons of TMJ surgery for internal disk derangements and arthropathy. Cranio 1986;4:74-85.
  • Montgomery MT, Gordon SM, Van Sickels JE, Harms SE. Changes in signs and symptoms following tem- poromandibular joint disc repositioning surgery. J Oral Maxillofac Surg 1992;50:320-8.
  • Montgomery MT, Van Sickels JE, Harms SE. Success of temporomandibular joint arthroscopy in disk dis- placement with and without reduction. Oral Surg Oral Med Oral Pathol 1991;71:651-9.
  • Simpson LL. The origin, structure, and pharmaco- logical activity of botulinum toxin. Pharmacol Rev 1981;33:155-88.
  • Brin MF. Botulinum toxin: chemistry, pharmacology, toxicity, and immunology. Muscle Nerve Suppl 1997; 6:S146-68.
  • Fujita S, Iizuka T, Dauber W. Variation of heads of lateral pterygoid muscle and morphology of articu- lar disc of human temporomandibular joint-anatom- ical and histological analysis. J Oral Rehabil 2001;28: 560-71.
  • Scott AB, Rosenbaum A, Collins CC. Pharmacologic weakening of extraocular muscles. Invest Ophthalmol 1973;12:924-7.
  • Scott AB. Botulinum toxin injection into extraocu- lar muscles as an alternative to strabismus surgery. Ophthalmology 1980;87:1044-9.
  • Jankovic J. Blepharospasm with basal ganglia lesions. Arch Neurol 1986;43:866-8.
  • Magoon EH. Chemodenervation of strabismic chil- dren. A 2- to 5-year follow-up study compared with shorter follow-up. Ophthalmology 1989;96:931-4.
  • Blitzer A, Brin MF, Greene PE, Fahn S. Botulinum toxin injection for the treatment of oromandibular dystonia. Ann Otol Rhinol Laryngol 1989;98:93-7.
  • Jankovic J, Schwartz K, Donovan DT. Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dys- phonia, other focal dystonias and hemifacial spasm. J Neurol Neurosurg Psychiatry 1990;53:633-9.
  • Cheshire WP, Abashian SW, Mann JD. Botulinum toxin in the treatment of myofascial pain syndrome. Pain 1994;59:65-9.
  • Freund B, Schwartz M. Temporal relationship of mus- cle weakness and pain reduction in subjects treated with botulinum toxin A. J Pain 2003;4:159-65.