How Do I Inject Botulinum Toxin Into the Lateral and Medial Pterygoid Muscles?

Abstract

Oromandibular dystonia is a focal dystonia that manifests as involuntary masticatory and/or tongue muscle contractions. Jaw opening, jaw deviation, and jaw protrusion types of oromamdibular dystonia are caused by involuntary contraction of the lateral pterygoid muscles. The medial pterygoid can be very hyperactive in jaw closing dystonia as a result of the so-called "whack-a-mole phenomenon," after repeated botulinum toxin injections into the masseter and temporalis muscles. The more accurately the botulinum toxin is injected into the muscles, the more likely the improvement in the patient's symptoms, and the lower the risk of complications, such as hematoma or arterial bleeding. Both pterygoid muscles can be accessed by intra-and extraoral routes. Safe and correct injection of botulinum toxin into both pterygoid muscles is described in this video. With understanding of the anatomy of the muscles, indications for injection, and technique of needle placement, injection of botulinum toxin into the lateral and medial pterygoid muscles is safe and effective for oromandibular dystonia.

Multilingual website and cyberconsultations for oromandibular dystonia

“…As a result, some patients were diagnosed with neurological diseases, including Parkinson’s disease, myasthenia gravis, epilepsy, and Guillain-Barre syndrome, by neurologists. The author applied a comprehensive range of treatments including medication, botulinum therapy (Botox ® ), 4 , 8 , 13-15 muscle afferent block therapy, 3 , 5 splint therapy 16 and oral and maxillofacial surgery. 9 , 10 …”

“…At our department, the author specializes in involuntary movements of the orofacial area. The author administers a comprehensive range of treatments for such involuntary movements, including medication, muscle afferent block therapy, 3 , 5 , 19 botulinum toxin therapy, 8 , 15 splint therapy 16 and surgery. 9 , 10 There are no hospitals or departments that specialize in oromandibular dystonia.…”

“…The author applies a precise and easy to perform method for injecting botulinum toxin involving the use of a computer-aided design/computer-aided manufacturingderived needle guide, which have been used as surgical templates for dental implant placement. 8 If local physicians could perform such injections using a needle insertion guide, it would be possible to reduce the economic burden and time constraints associated with repeated long-distance health tourism. Such needle guides can be used repeatedly (in the same patient) after re-sterilization.…”

Clinical and Phenomenological Characteristics of Patients with Task-Specific Lingual Dystonia: Possible Association with Occupation

“…The author has established a web site for patients with oromandibular dystonia, which has been accessed by more than one million visitors from over 190 countries and regions all over the world ( 37 ). At the author’s department, we offer a comprehensive range of multimodal therapies for involuntary movements of the orofacial region, including medication, muscle afferent block therapy ( 3 , 34 ), botulinum toxin therapy ( 37 , 38 ), splint therapy ( 39 ), Myomonitor, and surgery ( 35 , 56 ). Many patients with involuntary movements are referred to the author from all over Japan and, indeed, the world.…”

“…Patients were treated with a variety of combinations of pharmacotherapy, muscle afferent block therapy ( 3 , 34 ), botulinum toxin injection ( 37 , 38 ), splint therapy ( 39 ), and a Myomonitor (transcutaneous electro-neural stimulation) device. Subjective improvement was assessed using a linear self-rating scale ranging from 0% (no improvement) to 100% (complete cure).…”