Therapeutic Use of Botulinum Toxin Type A in Temporomandibular Myofascial Disorders: A Systematic Review.

BACKGROUND

This review explores the clinical role of botulinum toxin type A (BoNT-A) in treating Temporomandibular Disorders (TMDs) with a myofascial component, focusing on effectiveness, safety, injection protocols, and psychological and functional impact.

METHODS

Fourteen publications were retained for qualitative assessment after reviewing titles, summaries, and complete manuscripts. The risk of bias was appraised employing the ROBINS instrument.

RESULTS

BoNT-A treatment showed meaningful reductions in pain scores, especially in patients with high baseline pain or limited response to conservative care. Pain levels decreased significantly. Studies also reported improvements in jaw mobility, reduced muscle hyperactivity, and enhanced psychosomatic well-being. Some studies reported reductions in somatization and improvements in sleep quality. The depressive index remained unchanged, but functional disability improved significantly post-injection. Adverse effects, such as transient muscle soreness or facial changes, were rare and self-limiting. EMG data confirmed temporary neuromuscular relaxation lasting up to 22 weeks in some cases.

DISCUSSION: BoNT-A represents a valuable adjunctive or alternative therapy for myofascial TMDs, particularly in patients unresponsive to conventional treatments. It modulates pain perception and muscle overactivity via local and central mechanisms. However, variability in dosing, diagnostic criteria, and follow-up protocols underscores the need for standardized, well-designed clinical trials to optimize treatment strategies.

CONCLUSION

BoNT-A is a valuable alternative for patients unresponsive to standard therapies. It helps reduce muscle overactivity and pain perception through local and central mechanisms. However, lack of standardized dosing, variable diagnostic frameworks, and inconsistent follow-up protocols highlight the need for further well-designed clinical trials to guide optimal use (ID: 1106625).