(84) What is the Benefit of Botox in the Comprehensive Management of Temporomandibular Disorders?

Abstract:

Introduction: Temporomandibular joint disorder (TMD) is a chronic condition that causes pain and dysfunction to the jaw joint and muscles that control jaw movement. According to the National Institute of Health (NIH), TMD has a large prevalence, affecting 5-12% of the population. In this study, we were interested in examining chemodenervation of muscles of mastication with neurolytic agent, onabotulinumtoxinA (Botox). We designed and implemented a retrospective cohort study of subjects with TMD who presented to Parkland Oral and Maxillofacial Surgery Outpatient Clinic (OPC) between January 2024 and June 2024. Our objective was to identify how many patients with TMD benefited from chemodenervation therapy compared to patients that required further intervention to manage pain.
Materials and

Methods: We designed and implemented a retrospective cohort study. The study sample was derived from the population of patients who presented to the Department of Oral and Maxillofacial Surgery at Parkland Hospital OPC for evaluation and management of TMD/facial myalgia pain between January 1, 2024, and June 30, 2024. Subjects eligible for study inclusion had received at least one administration of Botox to manage TMD/facial myalgia between January 2024 and June 2024 and had failed 4-6 weeks of conservative management. Subjects were excluded from study enrollment if they had received alternative surgical treatment prior to or at the same time as Botox therapy, if they had an initial date of presentation prior to 2022, and if they had a documented history of maxillofacial trauma that could contribute to their chronic facial pain. We documented the date of initial presentation with TMD/myalgia symptoms and documented therapy in all subsequent appointments in 2024. For each appointment, we reviewed the location of pain, the maximum pain score on a scale of 0-10, the maximum interincisal opening (MIO), and the completed therapy during the appointment. All variables were input to Microsoft Excel.

Results: After review of records, 36 subjects met study inclusion and exclusion criteria. Average pain score was 5.8/10 on initial presentation and 4.0/10 after the most recent Botox administration. Average MIO was 37.3 mm on initial presentation and 37.0 mm after the most recent Botox administration. We were interested in trending the level of pain after the most recent Botox administration in 2024. Fourteen subjects returned for follow up after their most recent Botox administration. Nine out of 14 subjects reported improvement in pain and 5 out 14 subjects reported no improvement or worsening of pain. We additionally evaluated the recommended treatment for all patients after their most recent course of Botox therapy. Twenty-one patients were recommended to undergo specific therapy at the next visit. 8 out of 21 patients were advised that no further treatment was indicated. Six out of 21 patients were recommended to return for repeat Botox administration. Seven out of 21 subjects were recommended to and received further surgical intervention.

Conclusion: According to our study results, there was a significant decrease in pain score between the initial presentation with TMD symptoms and the presentation after the most recent Botox administration. There was an increase in the MIO after Botox therapy; however, the change in MIO was not significant. Therefore, we could not conclude that Botox significantly improved function. We established that only 7 out of 36 participants required progression to further surgical intervention while all other subjects were able to proceed with a less invasive course of therapy. As a result, we concluded that Botox therapy is a relatively low-risk and minimally invasive form of treatment to effectively manage TMD pain.
Summary of Study Variables for Entire SamplePain Trends at Follow up Visit after Most Recent Botox AdministrationRecommended Therapy after Most Recent Botox Administration