A型肉毒素治疗肌源性颞下颌关节紊乱病的研究进展

Research progress on the application of botulinum toxin type A in the treatment of myogenous temporomandibular disorders

摘要

肌源性颞下颌关节紊乱病（myogenous temporomandibular disorders，M-TMD）是颞下颌关节紊乱病（temporomandibular disorders，TMD）的主要亚型之一，肌痛为最典型表现，发病率呈逐年上升的趋势。A型肉毒素（botulinum toxin type A，BTX-A）是一种由肉毒杆菌产生的强效神经毒素，可抑制乙酰胆碱从突触前膜释放，从而阻断神经肌肉接头信号传导，使得注射区肌肉麻痹，BTX-A在口腔颌面部非美容性的应用是未来的研究热点。近年来越来越多研究聚焦于BTX-A用于M-TMD的治疗，文献回顾结果显示，在疼痛部位单次注射适宜剂量（单侧10~50 U）的BTX-A可在3~6个月内持续改善肌痛症状，必要时需重复注射。注射后常见不良反应如咀嚼无力、面瘫等均为暂时性，并可通过规范操作规避其发生，但目前临床仍缺少标准化的注射技术指南。

Abstract

Myogenous temporomandibular disorder (M-TMD) is one of the main subtypes of temporomandibular disorder (TMD) and typically manifests as masticatory myofascial pain; the incidence of TMD has been increasing annually in recent years. Botulinum toxin type A (BTX-A) is a potent neurotoxin produced by Clostridium botulinum. BTX-A inhibits the release of acetylcholine from the presynaptic membrane, thereby blocking neuromuscular junction signaling. The noncosmetic application of BTX-A in the oral and maxillofacial regions is a prominent research topic. In recent years, an increasing number of studies have focused on the application of BTX-A in the treatment of M-TMD. The results of a literature review revealed that an appropriate dose (10-50 U unilaterally) of BTX-A administered in a single injection into the masticatory muscles can effectively treat myalgia over a period of 3-6 months. Common adverse effects, such as masticatory weakness and facial paralysis, are transient and can be avoided by standardized injection techniques. However, there is a lack of standardized guidelines for injection techniques in clinical practice.

关键词

A型肉毒素 / 肌源性颞下颌关节病 / 颞下颌关节紊乱病 / 咀嚼肌 / 肌痛 / 乙酰胆碱 / 副作用 / 临床应用

Key words

botulinum toxin type A / myogenous temporomandibular disorders / temporomandibular disorders / masticatory muscles / myalgia / acetylcholine / adverse effects / clinical application

Author summay

陈奕帆，住院医师，硕士研究生在读，Email：[e-mail]