Outcomes of IncobotulinumtoxinA Injection on Myalgia and Arthralgia in Patients Undergoing Temporomandibular Joint Arthroscopy, 2023, Ângelo et al

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Outcomes of IncobotulinumtoxinA Injection on Myalgia and Arthralgia in Patients Undergoing Temporomandibular Joint Arthroscopy: A Randomized Controlled Trial

by
David Faustino Ângelo
1,2,3,4,*,
David Sanz
1,
Francesco Maffia
1,5and
Henrique José Cardoso
1


1
Instituto Português da Face, 1050-227 Lisboa, Portugal
2
Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
3
Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Marinha Grande, Portugal
4
Clínica Universitária de Estomatologia, Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria, 1649-028 Lisboa, Portugal
5
Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy
*
Author to whom correspondence should be addressed.
Toxins 2023, 15(6), 376; https://doi.org/10.3390/toxins15060376
Received: 10 May 2023 / Revised: 29 May 2023 / Accepted: 31 May 2023 / Published: 3 June 2023

(This article belongs to the Special Issue Botulinum Neurotoxin: Shared/Common Mechanisms in the Treatment of Pain, Spasticity and Movement Disorders)
Browse Figure

Figure 1
Revaluation six months post-treatment; * p ≤ 0.05.



Abstract

Background:

Several studies have considered Botulinum Neurotoxin Type A injections effective in treating temporomandibular joint disorder (TMD) symptoms. A double-blind, randomized, controlled clinical trial investigated the benefit of complementary incobotulinumtoxinA (inco-BoNT/A) injections in the masticatory muscles of patients submitted to bilateral temporomandibular joint (TMJ) arthroscopy.

Methods:

Fifteen patients with TMD and an indication for bilateral TMJ arthroscopy were randomized into inco-BoNT/A (Xeomin, 100 U) or placebo groups (saline solution). Injections were carried out five days before TMJ arthroscopy. The primary outcome variable was a Visual Analogue Scale for TMJ arthralgia, and secondary outcomes were the myalgia degree, maximum mouth opening, and joint clicks. All outcome variables were assessed preoperatively (T0) and postoperatively (T1—week 5; T2—6-month follow-up).

Results:

At T1, the outcomes in the inco-BoNT/A group were improved, but not significantly more than in the placebo group. At T2, significant improvements in the TMJ arthralgia and myalgia scores were observed in the inco-BoNT/A group compared to the placebo. A higher number of postoperative reinterventions with further TMJ treatments were observed in the placebo group compared to inco-BoNT/A (63% vs. 14%).

Conclusions:

In patients submitted to TMJ arthroscopy, statistically significant long-term differences were observed between the placebo and inco-BoNT/A groups.
Keywords:
Temporomandibular disorder; botulinum toxin; incobotulinumtoxinA; TMJ arthroscopy

Key Contribution: Complementary incobotulinumtoxinA (inco-BoNT/A) injections in the masticatory muscles of patients submitted to bilateral temporomandibular arthroscopy were effective in reducing pain and reducing the need for further reinterventions.

 

Doesn't surprise me. When I had ME undiagnosed 1986-96 I had a long period of TMJ in the context of various periodically shifting symmetrical joint pains, like shoulders, thumbs, big toes etc. So for a while in 1989 it was my TMJs turn and my jaw locked and I could barely move it to chew without excruciating pain, was eating a lot of soup.

Without an ME diagnosis (despite asking medical doctors) I had turned to alternative healing and buddhist philosophy to seek solutions and justify my need for rest and was doing a lot of meditating to improve my self awareness in the hope that would somehow fix it. Which it didn't but it did occasionally help me improve my management. So on this occasion I tried to use that method to focus on consciously relaxing my jaw muscles which I found were unconsciously tensed as well as the joint clearly being inflamed. It was surprisingly difficult to relax my jaw due to the deep seated psychological tension (sorry to use the P word but its true) manifesting as neuromuscular tension which I was experiencing from trying to survive undiagnosed with ME and zero recognition or support but once I did relax these muscles consciously, things started to improve for my TMJ pain and while the inflammation did not stop immediately the condition was less painful and the inflammation did eventually shift elsewhere of its own accord like it always did.

So I can believe that something like IncobotulinumtoxinA which disables muscle contraction and promotes relaxation might assist TMJ outcomes.

Though I can't help feeling it would also help if people were not made to feel so tense to start with, by medical attitudes, modern life, etc.