Anterior Disc Displacement
Conditions
Brief summary
The goal of this study is to evaluate intra-oral botulinum toxin type A injection into lateral pterygoid muscle using a surgical guide synthesized by virtual planning based on CT with soft tissue window. * To evaluate improvement of maximum interincisal opening (MIO) before and after injection. * To assess change in disc position before and after injection. * To evaluate recovery of symptoms as clicking, tenderness of TMJ and tenderness of lateral pterygoid muscle after injection. Researchers will compare intra-oral botulinum toxin type A injection using a surgical guide synthesized by virtual planning based on CT with soft tissue window to conventional EMG guided botulinum toxin injection into lateral pterygoid muscle in patient with anterior disc displacement with reduction. Participants will be injected with botulinum toxin type A by intraoral approach.
Interventions
PROCEDUREbotulinum toxin type A injection in lateral pterygoid muscle
* Needle insertion guide will be placed on upper teeth. * Needle will be inserted from needle insertion sleeve and 25-30 units of botulinum toxin type A will be injected. * Aspiration will be done before injection, and then, the patient will be asked to manipulate the mandible to activate the lateral pterygoid muscle.
PROCEDUREbotox injection in lateral pterygoid muscle
* A 27- gauge needle electrode will be inserted lateral to the maxillary tuberosity, just above the maxillary molars to inject 25-30 units of botulinum toxin type A under electromyographic guidance. * Aspiration will be done before injection, and then the patient will be asked to manipulate the mandible to activate the lateral pterygoid muscle. * The intramuscular injection will be confirmed when the electromyographic device produces a distinct loud sound.
Sponsors
Mahmoud Akram Khodir
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
1. Patients of both sexes that are diagnosed with ADDWR according to DC/TMD. 2. Their age range between 20 and 45 years. 3. Angle class I maxilla-mandibular relation.
Exclusion criteria
1. Patients with degenerative joint disease, musculoskeletal, neuromuscular disorders, cardiovascular, bleeding disorders, breathing difficulties, neurological disorders. 2. Pregnancy and lactating women. 3. History of surgical TMJ intervention. 4. Botox hypersensitivity 5. History of tumors or maxillofacial trauma. 6. Posteriorly edentulous saddles or anterior open bite. 7. Patient contraindicated to MRI examination
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| • Maximum interincisal opening in millimeters. | 6 months | measured in millimeters from incisal edge of uppercentrals to incisal edge of lower incisors by disposable rulers. |
| clicking | 6 months | Any noticeable sound detected temporomandibular joint during opening and closing |
| temporomandiular joint tenderness | 6 months | using visual analogue scale to measure pain intensity diagrammed in a line with two ends representing 0 ( no pain) and 10 ( the worst pain) after lateral and auriculotemporal palpation of temporomandibular joint |
| lateral pterygoid muscle tenderness | 6 months | using visual analogue scale to measure pain intensity diagrammed in a line with two ends representing 0 ( no pain) and 10 ( the worst pain) after intraoral palpation of lateral pterygoid muscle behind tuberosity |
Countries
Egypt
Outcome results
None listed