Objectives
This study sought to evaluate the efficacy of injecting botulinum toxin into the masseter and temporal muscles in patients with temporomandibular myofascial pain and sleep bruxism.
Materials and Methods
The study was conducted based on a clinical record review of 44 patients (36 females and eight males; mean age, 35.70±12.66 years). Patients who underwent the injection of botulinum toxin into the masseter and temporal muscles for the management of temporomandibular myofascial pain and sleep bruxism were included in the study. Patients were diagnosed based on the Diagnostic Criteria for Temporomandibular Disorders. Sleep bruxism was diagnosed according to the criteria defined by the American Academy of Sleep Medicine. The values of the visual analogue scale (VAS) and range of jaw motion, including unassisted maximum mouth opening (MMO), protrusion, and right and left laterotrusion, were observed preoperatively and postoperatively at one-, three-, and six-month follow-up visits.
Results
MMO, movements of the right and the left laterotrusion, and protrusion increased significantly (
P
<0.05), while VAS ratings decreased significantly at the three follow-up points relative to baseline values (
P
<0.05).
Conclusion
Botulinum toxin is an effective treatment for patients with temporomandibular myofascial pain and sleep bruxism.
developmental strides including walking independently and with appropriate for age language development. Since correction of the metopic craniosynostosis, patient had begun to exhibit facial features consistent with Lehman syndrome, including downslanting palpebral fissures, high arched eyebrows, mild hypertelorism, mild midface hypoplasia, long philtrum and thin upper lip. Future follow-up was scheduled with ophthalmology to monitor ICP, as well as continued craniofacial team care.
DISCUSSIONThis report discusses a unique patient with an uncertain natural history given the risk for CADASIL or Lehman syndrome and concurrent metopic craniosynostosis. Typically, patients with metopic craniosynostosis would undergo a full FOA with CVR. Although the procedure is not without its inherent risks including significant blood loss, surgical site infection, and anesthesia complications, this patient presented a particular conundrum in planning surgical her management. Given the well-characterized association of CADASIL with cerebral infarction, the decision was made by the attending plastic surgeon and neurosurgeon, in agreement with the family, to take a more conservative approach to the correction of craniosynostosis in order to minimize manipulation, however brief, of the frontal lobes during FOA osteotomies, and minimize the theoretical risk of intraoperative stroke. It was well understood by both the surgeons and family that omitting the FOA step of the procedure could potentially produce a suboptimal aesthetic result.Notably, the distinction between CADASIL and Lehman syndrome in this patient remains unclear. Although Lehman has previously been associated with craniofacial dysmorphisms, there are no reports of it in association with craniosynostosis. Additionally, the absence of any lateral meningoceles in our patient notably differs from the classic presentation of this syndrome. The patient will require regular follow-up with both the craniofacial team in order to evaluate possible new manifestations of her condition in childhood.
CONCLUSIONSThe case highlights the vital importance of multidisciplinary evaluation for patients with complex craniofacial syndromes. The operative management of a patient with craniosynostosis in the setting of risk for CADASIL and/or Lehman syndrome has not been previously reported in the literature.
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