The Temporo-Masseteric Nerve Block (TMNB) for Alleviating Acute Postextraction Masticatory Myalgia: A Case Series

Anesthesia Progress · 2025-03-01

This case series describes the ability of the temporo-masseteric nerve block (TMNB) to expeditiously relieve acute postextraction myogenous pain of masseteric or temporalis origin. In addition, the TMNB injection technique is also briefly reviewed. Briefly, 4 patients with no baseline temporalis or masseter muscle pain developed severe masseteric/temporalis pain during the first postoperative week on the side(s) of their dental extraction(s). The pain was accompanied by trismus. Both the pain and limitation in mouth opening were relieved by the TMNB injection, and symptom alleviation persisted beyond the brief duration of action of the administered local anesthetic. In conclusion, the TMNB injection can potentially serve as a valuable nonopioid adjunct to manage acute postextraction pain of masseteric or temporalis origin. It may be important to delineate acute myogenous postextraction pain from surgical site pain to optimize postoperative pain management and best alleviate trismus. Systematic validation of the TMNB's utility in postextraction pain management is warranted.

Safety, efficacy, and mechanism of action of the temporo-masseteric nerve block

Journal of Oral & Facial Pain and Headache · 2024-01-01

The objective of the study was to assess the utility and safety of Temporo-masseteric Nerve Block (TMNB), and to explore the mechanism for its apparent sustained pain relief. This manuscript describes, (1) a retrospective study evaluating pain reduction in patients who received the TMNB injection for the management of masticatory myogeneous pain (myalgia, per Diagnostic Criteria for Temporomandibular Disorders (DC/TMD criteria)), and (2) a motor nerve conduction study (NCS) of the temporalis and masseter, performed in the absence of signs or symptoms of TMD, before and after the TMNB injection. The results were as follows. (1) Retrospective study: (n = 186). 52 instances had available baseline and post-TMNB Numerical Pain Rating Scores (NRS) scores, the TMNB injection reduced baseline NRS scores by 70%; pain difference was qualitatively documented in 90 instances (pain relief or improvement in 86/90 instances). 4 instances yielded no pain relief. Mild adverse events recorded included a vasovagal episode (n = 1), transient weakening of blink (n = 2) or burning sensation (n = 1). (2) The Motor NCS demonstrated impairment of the compound-motor-action-potential (CMAP) as recorded from temporalis and masseter muscles following the TMNB injection. In conclusion, the TMNB injection is efficacious and safe. Further studies are warranted to warrant its effectiveness.

Adverse jaw outcomes from immune checkpoint inhibitors for head and neck cancer? Case reports.

PubMed · 2024-03-27

Radiation treatment plays a mainstream role in the management of head and neck squamous cell carcinomas (HNSCCs). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathologic fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCCs. Adverse impacts on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCCs exposed to both radiation treatment to the jaws and ICI therapy. This manuscript documents adverse jaw outcomes including osteonecrosis and pathologic fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC who had received prior radiation treatment. A potential link between immunotherapy and adverse jaw outcomes is consistent with the growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC. The general dental practitioner may encounter such patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management.

Medications Affecting Treatment Outcomes in Dentistry

Dental Clinics of North America · 2024-08-07 · 3 citations

Adverse jaw outcomes from immune checkpoint inhibitors for head-and-neck cancer? Case reports.

PubMed · 2024-02-01 · 1 citations

Radiation treatment plays a mainstream role in the management of head and neck cancers (HNSCC). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathological fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCC. Adverse impact on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCC exposed to both radiation treatment to the jaws and ICI therapy. This manuscript documents adverse jaw outcomes including osteonecrosis and pathological fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC and had received prior radiation treatment. A potential link between immunotherapy and adverse jaw outcomes is consistent with our growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC. The general dentist may encounter such patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management.

Myofascial Temporomandibular Disorders at a Turning Point

Dental Clinics of North America · 2023 · 7 citations

• Orthodontics
• Medicine
• Physical therapy

The relation of temporomandibular disorders and dental occlusion: a narrative review.

PubMed · 2022 · 47 citations

• Medicine
• Dentistry
• Orthodontics

OBJECTIVE: The term temporomandibular disorders (TMDs) encompasses a variety of disorders of the temporomandibular joint (TMJD) and the associated musculature (MMD). Occlusion and its role in the genesis of TMDs is one of the most controversial topics in this arena. The objective of the narrative review was to summarize the implications of TMDs and its relationship to dental occlusion in two scenarios: 1) TMD as an etiologic factor in dental occlusal changes; 2) The role of dental occlusion as a causative factor in the genesis of TMDs. DATA SOURCES: Indexed databases were searched from January 1951 to August 2021 using the terms TMJ, TMD, temporomandibular disorders, temporomandibular joint, and dental occlusion. CONCLUSION: There is lack of good primary research evaluating true association and showing the cause-and-effect relationship between dental occlusion and TMD. Systematic reviews suggest that the role of occlusion as a primary factor in the genesis of TMDs is low to very low. However, a variety of TMDs can lead to secondary changes in dental occlusion. Distinction between the two is paramount for successful management.

Nerve blocks in the management of acute temporomandibular disorder emergencies—a narrative review

Journal of Oral and Maxillofacial Anesthesia · 2022-04-12 · 4 citations

Background and Objective: Musculoskeletal disorders (MSDs) are among the prime contributors to disability worldwide affecting approximately 1.71 billion people. Temporomandibular disorders (TMDs) are one of the most frequently encountered MSDs of the orofacial region. Patients with TMD often present to the emergency room (ER) with acute emergencies or acute flare up of chronic conditions. Nerve blocks (NBs) are invaluable chairside tools that can be used for diagnostic and therapeutic purposes. The objective of the current narrative review is to familiarize healthcare professionals with clinical presentations and management of acute TMD emergencies using NBs. Methods: A search was conducted on indexed databases (PubMed, EMBASE, Scopus, ISI Web of Knowledge, Cochrane library) using keywords “temporomandibular disorders”, “emergencies” and “nerve block” from 1st January 1974 till 30th September 2021 and 298 articles were identified and approximately 100 relevant English full text articles were included in this narrative review. Key Content and Findings: TMD’s may present significant diagnostic and therapeutic dilemmas to a healthcare professional in an ER setting. Auriculotemporal NB, masseteric NB and temporo-masseteric nerve block (TMNB) are the most commonly used NBs to provide accurate diagnosis, immediate, effective pain relief and facilitate manual reduction procedures. Conclusions: NBs are indispensable tools that can be used in the ER to provide immediate and effective pain relief. NB can be used to solve diagnostic dilemmas by identifying the source of the pain and differentiating odontogenic from non-odontogenic causes in complex orofacial pain cases. They may also assist in improving pain related outcomes and manual reduction procedures.

Use of injection techniques in orofacial pain emergencies: a narrative review

Journal of Oral and Maxillofacial Anesthesia · 2022-09-01 · 1 citations

Background & Objective: Orofacial pain is the branch of dentistry that deals with non-odontogenic sources of pain in the head and neck area. It is the newest recognized specialty of dentistry. Urgent situations can and do occur in an orofacial pain setting. The objective of this review is to describe the various orofacial pain emergencies and describe injection techniques to manage them until definitive treatment can be instituted. Methods: The International Classification of Orofacial Pain guidelines were used and based on the extensive clinical experience of the authors, the commonly presenting orofacial pain emergencies were included in this narrative review. A PubMed search was done to gather the data. Key Content & Findings: Emergency conditions from temporomandibular disorders (TMDs) such as acute disc displacement without reduction, muscle spasm, acute primary myofascial pain, neuropathic orofacial pain disorders such as trigeminal neuralgia (TN), post-traumatic trigeminal neuropathic pain (PTNP), neurovascular disorders such as migraine and cluster headaches are presented along the relevant management injection techniques. Conclusions: This narrative summarizes the various emergency orofacial pain presentations and injection techniques for immediate management of the same.

Pragmatic management of myogenous temporomandibular disorder—a narrative review

Journal of Oral and Maxillofacial Anesthesia · 2022-12-01 · 1 citations

Background and Objective: Chronic pain is recognized as a disease state. Not understanding a complex chronic pain entity runs the risk of suboptimal diagnosis and management. The resulting undertreatment may exacerbate or perpetuate the state of chronic pain. Myofascial masticatory pain may well be one such entity. Several hypotheses implicate both local tissue pathology and central sensitization to play a role individually, or concomitantly. This narrative review aims to underscore three key factors that undermine the current management of masticatory myofascial pain—a lack of understanding of disease pathogenesis, its complex clinical heterogeneity, and the subjectivity in determining the choice of intervention. Methods: This non-systematic narrative review abstracts contemporary (up to 2022) literature on masticatory myofascial temporomandibular disorders (mTMD) pathophysiology and management published in PubMed database. Key Content and Findings: Currently, the choice of intervention in mTMD is primarily driven by the clinician’s expertise and subjective preferences. This manuscript briefly reviews current therapeutic options in mTMD. It summarizes emerging data supporting using the Temporo-masseteric Nerve Block (TMNB) as a diagnostic and therapeutic measure in its management. Conclusions: The TMNB injection holds promise as a means for diagnostic triage and therapeutic intervention in the management of mTMD. Until a more objective and quantitative diagnostic measure/s-based definition of mTMD has been identified that can, in turn, dictate targeted therapeutic intervention/s, clinicians managing mTMD may benefit from using the TMNB injection to gauge response and escalate care accordingly, Future research is warranted to validate its utility in the pragmatic management of mTMD and in identifying the need for multi-disciplinary patient management.