الفهرس 
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Abstract
This study was to evaluate and compare the effectiveness of BTX-A and PRP injections on muscle activity, visual analogue scale (VAS) for pain, pressure pain intensity (PPI) and jaw functional limitation scale (JFLS) in patients with myofascial TrPs within the masseter muscle.
It was conducted on 26 patients suffering from pain resulting from myofascial TrP in the masseter muscle selected from the outpatient Clinic of Alexandria Main University Hospital and operated in Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University.
Patients were divided into 2 groups:
group I: Consisting of 13 patients received Botulinum Toxin type A injection (BTX-A).
group II: Consisting of 13 patients received platelet rich plasma injection (PRP).
In preoperative stage
• Masseter muscle activity was assessed by EMG.
• Assessment of pain according to VAS and PPI.
• Assessment of jaw movements according to JFLS.
The operative procedure
• The area of maximum tenderness was identified within the masseter muscle by manual palpation.
• The TrPs were localized between the thumb and the index finger after antiseptic preparation of the skin with 70% ethyl alcohol.
• Trigger points injection sites were marked by a white pencil eyeliner.
group I
• Patients in this group were treated with BTX injection.
• The drug used was onabotulinumtoxinA Allergan 100 units.
• The BTX solution was prepared by dissolving 100 IU BTX into 2 ml of sodium chloride 9 mg/ml (0.9%) injection solution resulting in a clear solution containing the 100 units of the active ingredient in a concentration of 5 units per 0.1 ml of the reconstituted solution.
• Using a 21-gauge needle, the 2 ml saline was inserted into the vial and then the vial was tilted at a 45° angle
• Each TrP was injected with a single dose of 10 U BTX-A using a (1-ml, 30-gauge needle) insulin syringe.
group II
• Patients in this group were treated with PRP injection.
• Approximately 20 ml of venous blood was harvested from the patients and then transferred into four anticoagulant (3.2% Sodium citrate) vacutainer tubes.
• The PRP protocol used a double spin centrifugation process.
• The first centrifugation step was performed at 1,800 rpm for 15 min and three typical layers were found: red blood cells, PRP layer, and platelet poor plasma.
• The platelet poor plasma and PRP layer were transferred into another sterile tube without anticoagulant, and the second spin step was carried out at 3,500 rpm for 10 minutes. In this process, about 2-4 ml of pure PRP was obtained.
• A volume of 0.5 ml PRP was injected into each TrP using a (1-ml, 30-gauge needle) insulin syringe.
In postoperative stage
• Patients were recalled after 1, 3 and 6 months post-injection. Pain according to VAS and PPI and jaw movements were measured in the same manner as in the pre-operative phase.
• Electromyography readings were ordered at the end of the follow up period (6 months post-injection). The pre and post EMG readings were compared for changes in muscle activity.
Results
Regarding the EMG amplitude records, no significant difference was found in both groups.
Regarding the VAS, there was a significant difference in both groups till 3 months post-operatively. At the 6 months follow-up, no significant difference was found in both groups. There was significant reduction seen in VAS records of BTX group compared to the PRP group at the 3 & 6 months follow-up periods.
Regarding the PPI, both groups showed significant difference after 1 month post-injection. At the 3-months visit, PPI records of BTX group showed significant reduction while PPI records of PRP group weren’t significantly different than baseline values. At the 6 months follow-up, no significant difference was found in both groups.
Regarding the JFLS, significant improvement noticed in the BTX group at the 1, 3 post-injection follow-ups only with insignificant improvement detected after 6 months. The JFLS scores in the PRP group showed significant improvement at the 1 & 3 months follow-ups only.