Adverse Effects of Botulinum Toxin type-A injections in masticatory muscles on underlying bone and cartilage: a literature review

Abstract

Botulinum toxin type A (BTA) injections in masticatory muscles are used to treat numerous clinical conditions. This neurotoxin causes atrophy and transient paralysis of the concerned muscles.
The aim of this review is to gather and define the effects of BTA injections in masticatory muscles on the underlying cartilage and bone structures.
Electronic search of Medline and Google scholar databases covering the period between January 2007 and July 2019 was carried out. Eligible articles were selected according to the inclusion/exclusion criteria. Fourteen articles were included. BTA injections may cause short term reduction of cortical bone thickness and trabeculation. On the long term, cartilage volume reduction and bone volume loss were evident on the condyle and mandibular angle, at both
injected and non-injected mandibular bone structures. Bone mineral density remained unaffected when only one masticatory muscle was injected but was reduced when several masticatory muscles were treated with BTA. Several cellular and molecular alterations were noticed in some articles.
Because of evidence of irreversible negative effects of BTA on the underlying structures, possible muscle, bone and cartilage volume reduction should be communicated to the patients prior to any intervention. Further studies are needed to fully understand the cellular mechanisms and molecular responses behind this phenomenon.