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

Yıl 2009, Cilt: 19 Sayı: 3, 122 - 129, 08.06.2009

Atilla Arıncı Erdem Güven Mehmet Yazar Karaca Başaran Barış Keklik

Öz

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.

Anahtar Kelimeler

Botox, lateral pterygoid muscle, temporomandibular joint

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

Öz

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

Anahtar Kelimeler

Botox, lateral pterigoid kası, temporomandibüler eklem

Kaynakça

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