MEDICAL-TREATMENT OF RECURRENT TEMPOROMANDIBULAR-JOINT DISLOCATION USING BOTULINUM TOXIN-A

This paper describes a new technique for prophylactic treatment of rec urrent mandibular dislocation using injection of botulinum toxin A (Bt A) into the lateral pterygoid muscles. BtA temporarily weakens muscles by blocking acetylcholine release, and thus operates through a princi ple different from established treatments such as joint sclerosant the rapy, eminectomy or Dautry's procedure. The patient suffered recurrent mandibular dislocations caused by tardive dystonia. We injected 75 mu BtA percutaneously into each lateral pterygoid muscle under electromy ographic guidance. No further dislocations occurred over the subsequen t 10 months, and follow-up continues. There were no immediate or delay ed side effects. More experience is required before this becomes an es tablished treatment. BtA is usually given in outpatients, and is less invasive or destructive than previous options. It may not be suitable if dislocation is due to lax ligaments or weak muscles. Operators must be aware that other BtA preparations require a different dose.