Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Management of Lateral Pterygoid Myalgia with Diagnostic Local Anesthetic Injection: A Report of 2 Cases

진단적 국소마취 주사를 이용한 가쪽날개근 근육통의 치료 2 증례

  • Im, Yeong-Gwan (Department of Oral Medicine, Chonnam National University Hospital) ;
  • Kim, Byung-Gook (Department of Oral Medicine, School of Dentistry, Chonnam National University)
  • 임영관 (전남대학교치과병원 구강내과) ;
  • 김병국 (전남대학교 치의학전문대학원 구강내과학교실)
  • Received : 2010.08.17
  • Accepted : 2010.09.15
  • Published : 2010.12.30
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Abstract

The lateral pterygoid muscle is one of the masticatory muscles basic to jaw function. Because of its deep location in the masticatory system, digital palpation of the muscle is usually difficult to perform and unreliable. Therefore, diagnosis of the myalgic disorders involving the lateral pterygoid muscle is a perplexing problem for clinicians. Local anesthetic injection can be a more effective method to examine the lateral pterygoid muscle for the purpose of discriminating the source of pain. Furthermore, immediate elimination of muscle pain facilitates stretching of the muscle in the full range. We report two cases of lateral pterygoid myalgia that were diagnosed and managed successfully through the use of intramuscular local anesthetic injection.

가쪽날개근은 턱의 기능을 수행하는데 기본적인 저작근 중의 하나이다. 이 근육은 저작계의 심부에 위치하기 때문에 손가락을 이용한 촉진검사가 어려우며 그 결과도 신뢰할 만하지 못하다. 이러한 이유로 임상의에게 가쪽날개근에 이환된 근육통 질환을 진단하는 것은 쉽지 않은 문제이다. 근육내 국소마취 주사는 통증의 근원지를 감별하는 목적으로서 가쪽날개근을 검사하는 효과적인 방법이 될 수 있다. 또한 근육통을 즉각적으로 제거함으로써 근육을 전체 길이만큼 신장하는데 도움을 줄 수 있다. 저자들은 근육내 국소마취 주사를 이용하여 가쪽날개근의 근육통을 성공적으로 진단하고 치료한 두 증례를 보고하고자 한다.

Keywords

References

  1. Clemente CD. Gray's Anatomy. Philadelphia, USA: Lea and Febiger, 1985.
  2. Bertilsson O, Strom D. A literature survey of a hundred years of anatomic and functional lateral pterygoid muscle research. J Orofac Pain 1995;9: 17-23.
  3. Travell JG. Myofascial Trigger Points: Clinical View. In: Bonica JJ, Albe-Fessard D. Advances in Pain Research and Therapy. New York: Raven Press, 1976:919-926.
  4. Jacobs JW, Geenen R, van der Heide A, Rasker JJ, Bijlsma JW. Are tender point scores assessed by manual palpation in fibromyalgia reliable? An investigation into the variance of tender point scores. Scand J Rheumatol 1995;24:243-247. https://doi.org/10.3109/03009749509100882
  5. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301-355.
  6. Simons DG, Travell JG, Simons LS. Travell & Simon's myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins, 1999.
  7. Johnstone DR, Templeton M. The feasibility of palpating the lateral pterygoid muscle. J Prosthet Dent 1980;44:318-323. https://doi.org/10.1016/0022-3913(80)90020-7
  8. Conti PC, Dos Santos Silva R, Rossetti LM, De Oliveira Ferreira Da Silva R, Do Valle AL, Gelmini M. Palpation of the lateral pterygoid area in the myofascial pain diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e61-66.
  9. Stratmann U, Mokrys K, Meyer U, Kleinheinz J, Joos U, Dirksen D, et al. Clinical anatomy and palpability of the inferior lateral pterygoid muscle. J Prosthet Dent 2000;83:548-554. https://doi.org/10.1016/S0022-3913(00)70013-8
  10. Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol 1985;60:615-623. https://doi.org/10.1016/0030-4220(85)90364-0
  11. Wright EF. Referred craniofacial pain patterns in patients with temporomandibular disorder. J Am Dent Assoc 2000;131:1307-1315. https://doi.org/10.14219/jada.archive.2000.0384
  12. Okeson JP. Principles of pain diagnosis. Bell's orofacial pains: the clinical management of orofacial pain. Carol Stream: Quintessence, 2005:141-196.
  13. Okeson JP. Management of Temporomandibular Disorders and Occlusion. St. Louis: Mosby, 2003.
  14. Mense S. Nociception from skeletal muscle in relation to clinical muscle pain. Pain 1993;54:241-289. https://doi.org/10.1016/0304-3959(93)90027-M
  15. Svensson P, Arendt-Nielsen L, Nielsen H, Larsen JK. Effect of chronic and experimental jaw muscle pain on pain-pressure thresholds and stimulus-response curves. J Orofac Pain 1995;9:347-356.
  16. Thomas CA, Okeson JP. Evaluation of lateral pterygoid muscle symptoms using a common palpation technique and a method of functional manipulation. Cranio 1987;5:125-129. https://doi.org/10.1080/08869634.1987.11678182
  17. Iwama H, Ohmori S, Kaneko T, Watanabe K. Waterdiluted local anesthetic for trigger-point injection in chronic myofascial pain syndrome: evaluation of types of local anesthetic and concentrations in water. Reg Anesth Pain Med 2001;26:333-336.
  18. Foster AH, Carlson BM. Myotoxicity of local anesthetics and regeneration of the damaged muscle fibers. Anesth Analg 1980;59:727-736.
  19. Benoit PW, Belt WD. Some effects of local anesthetic agents on skeletal muscle. Exp Neurol 1972;34:264-278. https://doi.org/10.1016/0014-4886(72)90173-2
  20. Hogan Q, Dotson R, Erickson S, Kettler R, Hogan K. Local anesthetic myotoxicity: a case and review. Anesthesiology 1994;80:942-947. https://doi.org/10.1097/00000542-199404000-00029
  21. Salame TH, Peck CC, Murray GM. A new method for lateral pterygoid electromyographic electrode placement. J Prosthet Dent 2007;98:224-231. https://doi.org/10.1016/S0022-3913(07)60059-6
  22. Wright EF. Manual of temporomandibular disorders. Ames: Blackwell Munksgaard, 2005:190-191.