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Osteopenic consequences of botulinum toxin injections in the masticatory muscles: a pilot study
Author(s) -
Raphael K. G.,
Tadinada A.,
Bradshaw J. M.,
Janal M. N.,
Sirois D. A.,
Chan K. C.,
Lurie A. G.
Publication year - 2014
Publication title -
journal of oral rehabilitation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.991
H-Index - 93
eISSN - 1365-2842
pISSN - 0305-182X
DOI - 10.1111/joor.12180
Subject(s) - medicine , masticatory force , botulinum toxin , paresis , temporomandibular joint , osteopenia , condyle , dentistry , pterygoid muscles , cone beam computed tomography , orthodontics , anesthesia , osteoporosis , surgery , bone mineral , computed tomography
Summary Patients with temporomandibular muscle and joint disorder ( TMJD ) increasingly seek and receive treatment for their pain with botulinum toxin (Bo NTA ; botulinum toxin A). Used intramuscularly in therapeutic doses, it produces localised paresis. Such paresis creates risk of reduced bone mineral density, or ‘disuse osteopenia’. Animal studies have frequently used Bo NTA as a model of paralysis to induce bone changes within short periods. Osteopenic effects can be enduring in animals but have yet to be studied in humans. This is the first study in humans to examine bone‐related consequences of Bo NTA injections in the masticatory muscles, comparing oral and maxillofacial radiologists’ ratings of trabecular bone patterns in the condyles of patients with TMJD exposed to multiple masticatory muscle injection sessions with Bo NTA to a sample of patients with TMJD unexposed to masticatory muscle injections with Bo NTA . Cone‐beam computed tomography ( CBCT )‐derived images of bilateral condyles were evaluated in seven patients with TMJD receiving 2+ recent Bo NTA treatment sessions for facial pain and nine demographically matched patients with TMJD not receiving Bo NTA treatment. Two oral and maxillofacial radiologists evaluated CBCT images for evidence of trabecular changes consistent with osteopenia. Both evaluators noted decreased density in all participants exposed to Bo NTA and in none of the unexposed participants ( P < 0·001). No other abnormalities associated with reduced loading were detected. These findings need replication in a larger sample and over a longer time period, to ensure safety of patients with TMJD receiving multiple Bo NTA injections for their pain.