Botulinum toxin injections into masticatory muscles: A brief review on applications in dental occlusion management for orthognathic surgery and facial fractures.

BACKGROUND

Orthognathic and maxillofacial trauma surgeries are often challenged by postoperative instability resulting from persistent masticatory muscle forces acting on the repositioned bone segments. Botulinum toxin type A (BTX-A) has been proposed as an adjunctive intervention to transiently reduce these forces and enhance surgical stability.

OBJECTIVES

The aim of this narrative review was to evaluate the adjunctive role of BTX-A in orthognathic and maxillofacial trauma surgery, with particular emphasis on its potential to reduce postoperative masticatory muscle forces, thereby enhancing skeletal stability and optimizing healing. The review summarizes the current evidence regarding target muscles, dosing strategies, timing of administration, effects on skeletal and occlusal outcomes, and potential impact on bone regeneration. In addition, it identifies limitations in the existing clinical protocols and highlights areas requiring further standardized, high-quality research.

MATERIAL AND

METHODS

A narrative review was conducted using the PubMed, Scopus, and Web of Science databases to identify experimental, clinical and case-based studies investigating the use of BTX-A in orthognathic surgery and maxillofacial trauma management. The reference lists of relevant articles were also manually screened to identify additional key mechanistic and translational evidence.

RESULTS

Botulinum toxin type A injections into the masseter, temporalis and digastric muscles may reduce postoperative muscle tension, protect fixation hardware, and improve skeletal and occlusal stability. The available studies suggest a transient 20-40% reduction in bite force lasting approx. 3-4 months, corresponding to the critical period of bone healing. Experimental models also indicate a potential beneficial effect on bone regeneration.

CONCLUSIONS

Botulinum toxin type A represents a minimally invasive and biologically plausible adjunct for enhancing outcomes in orthognathic and maxillofacial trauma surgery. However, standardized protocols regarding dosing, timing of administration, and safety have yet to be established. Well-designed controlled clinical trials are needed to define its optimal use, alongside ethical guidance addressing its off-label application and use in pediatric patients.