Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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The Influence of Botulinum Toxin Type A Masticatory Efficiency

보툴리눔 A형 독소가 저작효율에 미치는 영향

  • Park, Hyung-Uk (Department of Orofacial Pain & Oral Medicine, Yonsei Dental Hospital, Yonsei University Colledge of Dentistry) ;
  • Kwon, Jeong-Seung (Department of Orofacial Pain & Oral Medicine, Yonsei Dental Hospital, Yonsei University Colledge of Dentistry) ;
  • Kim, Seong Taek (Department of Orofacial Pain & Oral Medicine, Yonsei Dental Hospital, Yonsei University Colledge of Dentistry) ;
  • Choi, Jong-Hoon (Department of Orofacial Pain & Oral Medicine, Yonsei Dental Hospital, Yonsei University Colledge of Dentistry) ;
  • Ahn, Hyung-Joon (Department of Orofacial Pain & Oral Medicine, Yonsei Dental Hospital, Yonsei University Colledge of Dentistry)
  • 박형욱 (연세대학교 치과대학 구강내과학교실) ;
  • 권정승 (연세대학교 치과대학 구강내과학교실) ;
  • 김성택 (연세대학교 치과대학 구강내과학교실) ;
  • 최종훈 (연세대학교 치과대학 구강내과학교실) ;
  • 안형준 (연세대학교 치과대학 구강내과학교실)
  • Received : 2013.02.12
  • Accepted : 2013.03.04
  • Published : 2013.03.30
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Abstract

This study was aimed to evaluate the masticatory efficiency after botulinum toxin type A (BTX-A) injection during 12 weeks using objective and subjective test. Also, we compared the difference of masticatory efficiency between group that injected into the masseter muscle only (M-group) and group that injected into the masseter and temporalis muscle (M-T group). The mixing ability index (MAI) was used as the objective indicator, and visual analogue scale (VAS) and food intake ability (FIA) index were used as the subjective indicators. It was concluded that masticatory efficiency was significantly lowered after a BTX-A injection into the masticatory muscle, but it gradually recovered in a predictable pattern by the 12 weeks. The disturbance of subjective masticatory efficiency was lasted longer than objective masticatory efficiency. The masticatory efficiency was lower in M-T group than M group. It was statistically significant in the VAS and FIA at 4 weeks, but the MAI showed no significancy. After 4weeks, there was rapid recovery of muscle function in M-T group, and the difference between two groups was not significant. It could be concluded that there will be no serious disturbance of mastication compared to injection is done only into the masseter muscle, even if injection is done into the masseter and temporalis muscle in dose of this study. According to the food properties, it was confirmed that people feel more discomfort on taking hard and tough foods after BTX-A injection and not only hard foods, but also intake of soft and runny foods were influenced by botulinum toxin injection.

보툴리눔 독소는 Clostridium botulinum이라는 박테리아가 만들어내는 독소를 의료용으로 희석, 정제한 약제로서 이 독소가 시냅스 전 신경말단에 부착되어 신경근접합부에서 아세틸콜린의 분비를 억제함으로써 근육의 수축을 차단하는 역할을 한다. 보툴리눔 독소 주사 요법은 구강안면 분야에서 저작근의 근경축, 근경련, 운동이상증, 측두하악관절질환, 근막통증, 이갈이, 특발성 교근비대증 또는 만성편두통을 비롯한 두통 등 다양한 질환에서 가역적, 보존적 치료법으로 활발히 사용되고 있다. 사용 범위가 넓어지면서 교근이나 측두근 같은 저작근 부위에 주사를 하는 경우가 많아지고 있으며 그러한 경우 약제자체의 약리학적 작용에 의해 일시적인 근마비 및 근위축에 따라 저작기능에 변화가 생기게 된다. 하지만 지금까지 보툴리눔 독소 주사치료의 효과나 활용에 대한 연구만이 주를 이루었고 부작용 중의 하나인 저작기능 변화에 대한 연구는 거의 이루어지지 않았다. 몇몇 저작기능과 관련한 연구 또한 근전도 등을 이용한 정적인 상태의 저작력 감소에 대한 연구로, 실제로 동적인 저작 환경을 반영하는 저작 효율에 대해서는 현재까지 전혀 연구가 이루어지지 않은 실정이다. 이에 본 연구에서는 총 40명의 건강한 성인환자를 대상으로 보툴리눔 A형 독소 주사 요법을 교근 부위에만 시술 받은 사람 과 교근과 측두근 부위 모두에 시술 받은 사람 각각 20명씩 두 군으로 나누어 주사를 시행하고, 주사 전과 주사 후 4주, 8주, 12주째의 저작 효율의 변화를 주관적 평가방법인 식품섭취능 (Food Intake Ability, 이하 FIA)과 저작 능력에 대한 주관적 인식도 (Visual Analogue Scale, 이하 VAS), 객관적 평가 방법인 Mixing Ability Test를 시행하여 알아보았다. 그 결과 보툴리눔 A형 독소 주사 후 4주 째에 저작효율의 뚜렷한 감소가 나타났으며 이후 서서히 회복되는 경향을 보였다. 주사부위를 달리하여 본 결과 교근과 측두근에 모두 주사를 시행하는 경우, 교근에만 주사를 시행하는 경우에 비해 주관적, 객관적인 값 모두 낮게 나타났다. 주관적인 값에 있어서 4주 째 유의하였으나 이후에는 유의하지 않았으며 객관적인 값은 전 기간에 걸쳐 유의하지 않았다. 실험에서 정한 주사 용량에 대해서는 측두근까지 주사가 이루어지더라도 교근만 주사를 시행한 사람과 비교하여 저작효율의 큰 차이가 없는 것으로 보인다. 또한 식품성상에 따라 저작 효율을 살펴본 결과 보툴리눔 A형 독소 주사가 단단하고 질긴 음식 섭취에 더 큰 영향을 미치는 것으로 보이며 무르고 약한 음식의 섭취 시에도 유의할만한 영향을 받는다는 사실을 확인 할 수 있었다.

Keywords

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