Botulinum toxin versus Fascial Manipulation tecnique in the treatment of chronic facial pain associated with temporo-mandibular dysfunction.

Introduction: The present investigation is a preliminary randomized clinical trial with the aim to assess the efficacy of type A botulinum toxin and Fascial Manipulation tecnique to treat myofascial pain symptoms and to reduce muscle hyperactivity in bruxism. Materials and methods. Thirty patients (22 males, 8 females; age range 23-69 years) with a diagnosis of chronic facial pain associated with myofascial syndrome were randomly divided in 2 groups: 15 subjects (9 women, 6 men, mean age 44) were treated with botulinum toxin injections (group A) and 15 subjects (10 women, 5 men, mean age 49) were treated with four sessions of Fascial Manipulation technique (group B). All the patients were assessed with the Research Diagnostic Criteria for Temporomandibular Disorders axis II (intensity of facial pain, limitation of ADL) Results. The group A showed a decrease in pain (from 8.1 to 6.8 of the VAS scale) and in the masticatory pain (from 4.6 to 3.8). Moreover, botulinum toxin injections permit to quit habits of tooth grinding and clenching. There are no side effects further a “fixed” smile for about 6 to 8 weeks. In group B a reduction of pain intensity was evident (from 6 to 2.1). Significant differences were found in rest pain between pre-intervention and both post-intervention and one month follow-up periods. Besides, all the participants reported reductions in headache frequency and intensity over time, although only in the group B this improvement was statistically significant (88.5%). Surface electromyography mesured a decrease of frequency (microvolt) and amplitude of muscle activity in both groups, but higher in group A. Conclusion. Results from the present study support the efficacy of BTX-A and Fascial Manipulation technique to reduce myofascial pain symptoms in bruxism, and it is probably that using both the methods could further improved the outcomes. A larger definitive trial will be needed to confirm this hypothesis.