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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.

SUBMITTER: Yoshida K

PROVIDER: S-EPMC6353475 | biostudies-other | 2017 Mar-Apr

REPOSITORIES: biostudies-other

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

Yoshida Kazuya K

Movement disorders clinical practice 20161214 2

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 ...[more]

PMID: 30838273

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Project description:PurposeMotor unit activity is coordinated between many synergistic muscle pairs but the functional role of this coordination for the motor output is unclear. The purpose of this study was to investigate the short-term modality of coordinated motor unit activity-the synchronized discharge of individual motor units across muscles within time intervals of 5ms-for the Vastus Medialis (VM) and Lateralis (VL). Furthermore, we studied the task-dependency of intermuscular motor unit synchronization between VM and VL during static and dynamic squatting tasks to provide insight into its functional role.MethodsSixteen healthy male and female participants completed four tasks: Bipedal squats, single-leg squats, an isometric squat, and single-leg balance. Monopolar surface electromyography (EMG) was used to record motor unit activity of VM and VL. For each task, intermuscular motor unit synchronization was determined using a coherence analysis between the raw EMG signals of VM and VL and compared to a reference coherence calculated from two desynchronized EMG signals. The time shift between VM and VL EMG signals was estimated according to the slope of the coherence phase angle spectrum.ResultsFor all tasks, except for singe-leg balance, coherence between 15-80Hz significantly exceeded the reference. The corresponding time shift between VM and VL was estimated as 4ms. Coherence between 30-60Hz was highest for the bipedal squat, followed by the single-leg squat and the isometric squat.ConclusionThere is substantial short-term motor unit synchronization between VM and VL. Intermuscular motor unit synchronization is enhanced for contractions during dynamic activities, possibly to facilitate a more accurate control of the joint torque, and reduced during single-leg tasks that require balance control and thus, a more independent muscle function. It is proposed that the central nervous system scales the degree of intermuscular motor unit synchronization according to the requirements of the movement task at hand.

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

Publications

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

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