Ultrasound‐Guided Injection of the Temporalis Tendon: A Novel Technique

Bressler, Hart B.; Friedman, Talia; Friedman, Lawrence

doi:10.1002/jum.14232

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…US offers several advantages, including the absence of ionizing radiation, shorter image acquisition time than that of conventional radiography, real-time evaluation of dynamic anatomical structures, and the ability to detect major blood vessels using Doppler mode (Bressler et al, 2017;Oeppen et al, 2010;Shah et al, 2014). Owing to these advantages, several studies have explored the use of US in dental research, particularly in the fields of periodontology, orofacial pain, and oral medicine (Baek et al, 2009;Jonsson & Baldini, 2016;Salmon & Le Denmat, 2012;Xiang et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Anatomical consideration of ultrasonography‐guided intraoral injection for temporal tendinitis

Kim,

Bae,

Lee

et al. 2023

Clinical Anatomy

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Temporal tendinitis is characterized by acute inflammation often resulting from mechanical stress, such as repetitive jaw movements associated with jaw opening and closing and teeth clenching. Treatment for temporal tendinitis typically involves the administration of local anesthetic or corticosteroid injections. However, the complex anatomical structure of the coronoid process, to which the temporalis tendon attaches, located deep within the zygomatic arch, poses challenges for accurate injections. In this study, we aimed to establish guidelines for the safe and effective treatment of temporal tendinitis by using intraoral ultrasonography (US) to identify the anatomical structures surrounding the temporalis tendon and coronoid process. US was performed using an intraoral transducer on 58 volunteers without temporomandibular joint disease. The procedure involved placing the transducer below the occlusal plane of the maxillary second molar. Measurements were taken for the horizontal distance from the anterior border of the coronoid process, observed at the midpoint (MP) of the US images, and the depth of the coronoid process and temporalis muscle from the oral mucosa. The anterior border of the coronoid process was visualized on all US images and classified into three observed patterns at the MP: type A (anterior to the MP, 56.2%), type B (at the MP, 16.1%), and type C (posterior to the MP, 27.7%). The temporalis muscle was located at a mean depth of 3.12 ± 0.68 mm from the oral mucosa. The maxillary second molar is an intraoral landmark for visualizing the anterior border of the coronoid process. The new location information obtained using intraoral US could help identify the safest and most effective injection sites for the treatment of temporal tendinitis.

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Section: Discussionmentioning

confidence: 99%

Anatomical consideration of ultrasonography‐guided intraoral injection for temporal tendinitis

Kim,

Bae,

Lee

et al. 2023

Clinical Anatomy

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“…These results may also have an impact on the choice of therapy. Various local infiltration therapies are propagated for CMD patients, including the use of local anesthetics, corticosteroids [23], and especially botulinum toxin [10,[24][25][26][27]. Such therapeutic applications in the temporal tendon region have to be discussed in view of the morphological results on MRI, especially considering the side effects of this therapy.…”

Section: Discussionmentioning

confidence: 99%

Temporal Tendinitis in Craniomandibular Dysfunction (CMD) – Does it Really Exist? A Temporomandibular MRI Investigation

Stimmer

Grill

Waschulzik

et al. 2022

Rofo

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Objectives The aim of the study was to analyze the role of temporal muscle and particularly tendon pathology in patients suffering from craniomandibular dysfunction (CMD) using magnetic resonance imaging. Materials and Methods Retrospective analysis of MRI examinations was carried out with regard to temporal muscle fibrosis and fatty degeneration and particularly temporal tendon rupture, thickening, and degenerative signal alterations. Descriptive statistics and the Mann-Whitney U-test were used for statistical evaluation. Results Structural lesions of temporal muscle parenchyma were the absolute exception. PD hyperintensity, pronounced contrast enhancement, or peritendinous fluid collections along the temporal tendon were found only to a small extent, and a (partial) rupture occurred in only one case. The tendon diameter showed only slight variability. The Mann-Whitney U-test provided no results indicating a causal connection between degenerative joint or disc disease and temporal tendon pathology. Conclusion A large sample of 128 magnetic resonance imaging examinations provided no evidence of a major role of temporal tendinitis in clinical CMD syndrome. Key Points: Citation Format

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“…The most common explanation for the empirical efficacy of the temporalis tendon injection is that the source of pain is the temporalis tendon and as such targeting this structure with local anesthetic will reduce pain intensity and frequency. An alternative hypothesis is that since the temporalis tendon is in close proximity to other structures (13,14), specifically the branches of the trigeminal nerve, and because the temporalis tendon is surrounded by soft tissue, the analgesic fluid can easily spread out and affect other nerves such as the masseteric and temporal nerves causing a nerve block. Reports in the literature of a temporalis tendon injection aborting headaches, including migraine seem to support this hypothesis (15).…”

Section: Introductionmentioning

confidence: 99%

Mechanical sensitivity changes in pericranial muscles after local anesthesia and experimentally induced pain in the temporalis tendon: Implications for headache and facial pain

et al. 2022

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Objectives To assess changes in mechanical sensitivity of the pericranial muscles in healthy individuals after a local anesthetic block of the temporalis tendon. In addition, to assess, if experimentally induced temporalis tendon pain, can lead to an increase in mechanical sensitivity of the pericranial muscles and reports of headache. Methods 40 healthy participants were recruited for this randomized, double-blinded, controlled experiment, and were randomly injected with mepivacaine and isotonic saline into the dominant-side temporalis tendon in two different sessions, and either nerve growth factor (n = 20) or isotonic saline (n = 20) in a third session. Mechanical sensitivity was assessed in the temporalis, masseter, and trapezius muscles as well as in the temporalis tendon, on the dominant side, before and 10 minutes after each injection, and in a fourth session two days after the third session. Pain drawings and headache diaries were kept for 30 days after the final session to register any developing pain or headache. Results Mepivacaine injection into the temporalis tendon caused a significant decrease in mechanical sensitivity in the temporal tendon (−54.5%) and the masseter (−15.4%) muscle (P < 0.05) but not the temporalis (−12.1%) and trapezius muscles (−12.7%) (P > 0.05). Nerve growth factor injection into the temporalis tendon caused a significant increase in mechanical sensitivity in the tendon (+15.4%) and masseter muscle (+14.4%) (P < 0.05) but not the temporalis (+2.8%) or trapezius muscles (+3.1%) (P > 0.05). A significant increase was found for headache frequency in the first seven days (P < 0.05) after nerve growth factor injection compared to after isotonic saline injection, but not intensity (P > 0.05). Conclusion These findings suggest that the therapeutic effect of temporalis tendon anesthetic injections on facial pain and headaches are most likely not only due to a direct effect of the local anesthetic on the temporalis tendon but rather to a more generalized block of the nerves in the area. In addition, the temporal tendon may contribute to the pathophysiological processes of headache.

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Ultrasound‐Guided Injection of the Temporalis Tendon: A Novel Technique

Cited by 7 publications

References 12 publications

Anatomical consideration of ultrasonography‐guided intraoral injection for temporal tendinitis

Anatomical consideration of ultrasonography‐guided intraoral injection for temporal tendinitis

Temporal Tendinitis in Craniomandibular Dysfunction (CMD) – Does it Really Exist? A Temporomandibular MRI Investigation

Mechanical sensitivity changes in pericranial muscles after local anesthesia and experimentally induced pain in the temporalis tendon: Implications for headache and facial pain

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