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A cadaveric analysis of the efficacy of blind injections into the lateral pterygoid muscle. | LitMetric

A cadaveric analysis of the efficacy of blind injections into the lateral pterygoid muscle.

Folia Morphol (Warsz)

Discipline of Anatomy, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.

Published: December 2024

AI Article Synopsis

  • Temporomandibular disorders (TMD) are a leading cause of orofacial pain, with hyperactivity of the lateral pterygoid muscle (LPM) often implicated; botulinum toxin A (BTX) injections into this muscle can be a treatment but lack standardization.
  • A study conducted on five cadavers using extraoral landmark-based LPM BTX injections revealed a 0% accuracy rate and significant neurovascular disruption in 40% of cases.
  • The findings underline the dangers of blind BTX injections for TMD and emphasize the need for improved treatment protocols, including the use of guided imaging techniques.

Article Abstract

Background: Temporomandibular disorders (TMD) are amongst the most common causes of orofacial pain. Hyperactivity of the lateral pterygoid muscle (LPM) is associated with the pathological mechanisms associated with TMD. Botulinum Toxin-A (BTX) injections into the LPM can be used as a treatment for TMD; however, a lack of clinical standardisation for this procedure can lead to adverse outcomes, especially when using anatomical landmark-based approaches.

Materials And Methods: To better understand the precision of extraoral landmark-based LPM BTX injections, a maxillofacial surgeon injected 1.5 mL of 0.25% methylene blue dye into the LPM of five cadavers. Needle location, dye spread, and disrupted structures were then examined through cadaveric dissection.

Results: Landmark-based LPM BTX approaches resulted in poor outcomes in accuracy (0%) and a 40% incidence of neurovascular disruption, including the facial plexus, superficial temporal artery and superficial temporal vein.

Conclusions: Randomised controlled trials have highlighted the risks associated with extraoral botulinum toxin injections for TMD symptomatic relief. This report demonstrates the low accuracy rate and high neurovascular risk accompanying blind LPM injections and highlights the necessity of safe treatment protocols in TMD, in particular guided image-based diagnostics and procedures.

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Source
http://dx.doi.org/10.5603/fm.102905DOI Listing

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