The efficacy of botulinum toxin injections and orofacial myofunctional therapy on orofacial disorders: A systematic review of clinical studies

Maryam Altuhafy; Alfred Ravikumar; Mayaf Altuhafy; Junad Khan

doi:10.53730/ijhs.v10n1.15894

Authors

Maryam Altuhafy
maryam_altuhafy@urmc.rochester.edu
University of Rochester, NY, USA
Alfred Ravikumar University of Rochester, NY, USA
Mayaf Altuhafy High Diplomate in Restorative Dentistry, Dubai, UAE
Junad Khan University of Rochester, NY, USA

Keywords:

Botulinum toxin A injections, Facial Exercises, Orofacial pain disorders

Abstract

Background: Botulinum toxin injections are widely used in the orofacial region for cosmetic and therapeutic purposes. Recently, interest has grown in combining Botulinum toxin A injection with facial exercises to enhance or sustain aesthetic and functional outcomes. Objective: To examine the efficacy of Botulinum toxin injections with facial exercise on orofacial disorders. Methods: A comprehensive electronic literature search was conducted across databases. Studies were screened for eligibility, and reviewers independently assessed quality and bias. Results: An electronic search of databases up until Feb 2026 revealed 164,916 Articles. Seven studies met the inclusion criteria, including four RCTs and three prospective clinical studies conducted in a hospital-based setting. Different Botulinum toxins have been used in these studies. Two studies used Onabotulinumtoxin A, two used botulinum toxin (Dysport), and two RCTs used botulinum A toxin (Botox). Additionally, the presented studies performed various myofunctional therapy. Conclusion: The current evidence suggests that facial exercise following Botulinum toxin A injections may enhance treatment outcomes in the orofacial area by sustaining muscle tone and prolonging aesthetic benefits. Further research with larger sample sizes and standardized protocols must establish the effectiveness and best practices of this combined approach.

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References

Ainsworth, J. R., & Kraft, S. P. (1995). Long-term changes in duration of relief with botulinum toxin treatment of essential blepharospasm and hemifacial spasm. Ophthalmology, 102(12), 2036-2040. https://doi.org/10.1016/S0161-6420(95)30757-9 DOI: https://doi.org/10.1016/S0161-6420(95)30757-9

Altuhafy, M. R., Yadav, R., Talluri, S., Jabr, L., Kalladka, M., & Khan, J. (2022). The Efficacy of Botulinum Toxin in the Management of Restless Leg Syndrome: A Systematic Review of Randomized Control Trials. Indian Journal of Sleep Medicine, 17(1), 15-21. DOI: https://doi.org/10.5005/jp-journals-10069-0097

Altuhafy, M., Ahmed, S., Jabr, L., & Khan, J. (2024). Effectiveness of photobiomodulation and orofacial myofunctional therapy in orofacial pain disorders. A systematic review of randomized control trials. Lasers in Medical Science, 39(1), 127. DOI: https://doi.org/10.1007/s10103-024-04073-4

Altuhafy, M., Lilo, R., Jabr, L., Korczeniewska, O. A., & Khan, J. (2023). Effectiveness of cold application on postoperative pain following botulinum toxin injections type a in the orofacial region: a systematic review of randomized controlled studies. Aesthetic Medicine, 9(4), e2023023.

Azuma, T., Nakamura, K., Takahashi, M., Ohyama, S., Toda, N., Iwasaki, H., ... & Takeda, N. (2012). Mirror biofeedback rehabilitation after administration of single-dose botulinum toxin for treatment of facial synkinesis. Otolaryngology--Head and Neck Surgery, 146(1), 40-45. DOI: https://doi.org/10.1177/0194599811424125

Bednarczyk, V., Proulx, F., & Paez, A. (2024). The effectiveness of cervical rehabilitation interventions for pain in adults with myogenic temporomandibular disorders: A systematic review and meta‐analysis. Journal of Oral Rehabilitation, 51(6), 1091-1107. DOI: https://doi.org/10.1111/joor.13671

Delcanho, R., Val, M., Nardini, L. G., & Manfredini, D. (2022). Botulinum toxin for treating temporomandibular disorders: what is the evidence?. Journal of oral & facial pain and headache, 36(1), 3023. DOI: https://doi.org/10.11607/ofph.3023

Ferrillo, M., Giudice, A., Marotta, N., Fortunato, F., Di Venere, D., Ammendolia, A., ... & De Sire, A. (2022). Pain management and rehabilitation for central sensitization in temporomandibular disorders: a comprehensive review. International journal of molecular sciences, 23(20), 12164. DOI: https://doi.org/10.3390/ijms232012164

Guarda-Nardini, L., Stecco, A., Stecco, C., Masiero, S., & Manfredini, D. (2012). Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. CRANIO®, 30(2), 95-102. DOI: https://doi.org/10.1179/crn.2012.014

Higgins, J. P., Savović, J., Page, M. J., Elbers, R. G., & Sterne, J. A. (2019). Assessing risk of bias in a randomized trial. Cochrane handbook for systematic reviews of interventions, 205-228. DOI: https://doi.org/10.1002/9781119536604.ch8

Hong, S. O. (2023). Cosmetic treatment using botulinum toxin in the oral and maxillofacial area: a narrative review of esthetic techniques. Toxins, 15(2), 82. DOI: https://doi.org/10.3390/toxins15020082

Kalladka, M., Young, A., & Khan, J. (2021). Myofascial pain in temporomandibular disorders: Updates on etiopathogenesis and management. Journal of Bodywork and Movement Therapies, 28, 104-113. https://doi.org/10.1016/j.jbmt.2021.07.015 DOI: https://doi.org/10.1016/j.jbmt.2021.07.015

La Fleur, P., & Adams, A. (2020). Botulinum toxin for temporomandibular disorders: a review of clinical effectiveness, cost-effectiveness, and guidelines.

Lee, J. M., Choi, K. H., Lim, B. W., Kim, M. W., & Kim, J. (2015). Half-mirror biofeedback exercise in combination with three botulinum toxin A injections for long-lasting treatment of facial sequelae after facial paralysis. Journal of Plastic, Reconstructive & Aesthetic Surgery, 68(1), 71-78. https://doi.org/10.1016/j.bjps.2014.08.067 DOI: https://doi.org/10.1016/j.bjps.2014.08.067

Mazlout, H., Triki, W., Kéfi, S., Brour, J., El Afrit, M. A., Chéour, M., & Kraiem, A. (2012). Safety and efficacy of botulinum toxin in hemifacial spasm. Journal Francais D'ophtalmologie, 36(3), 242-246. DOI: https://doi.org/10.1016/j.jfo.2012.01.011

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj, 372. DOI: https://doi.org/10.31222/osf.io/v7gm2

Pereira, L. M., Obara, K., Dias, J. M., Menacho, M. O., Lavado, E. L., & Cardoso, J. R. (2011). Facial exercise therapy for facial palsy: systematic review and meta-analysis. Clinical rehabilitation, 25(7), 649-658. DOI: https://doi.org/10.1177/0269215510395634

Pitakpatapee, Y., Soontrapa, P., Suengtaworn, A., Srikajon, J., Sangpeamsook, T., Komoltri, C., & Srivanitchapoom, P. (2021). Effect of combined facial exercise with botulinum toxin A on health-related quality of life in Thai adults with hemifacial spasm: a randomised controlled pilot cross-over trial. Journal of Neurology, Neurosurgery & Psychiatry, 92(3), 337-339. DOI: https://doi.org/10.1136/jnnp-2020-323604

PO’Reilly, P., Ross, J., Norris, J., & Malhotra, R. (2012). A comparison of facial muscle squeezing versus non-facial muscle squeezing on the efficacy of botulinumtoxin-A injections for the treatment of facial dystonia. Orbit, 31(6), 400-403. DOI: https://doi.org/10.3109/01676830.2012.711885

Pourmomeny, A. A., Asadi, S., & Cheatsaz, A. (2015). Management of facial synkinesis with a combination of BTX-A and biofeedback: a randomized trial. Iranian journal of otorhinolaryngology, 27(83), 409. DOI: https://doi.org/10.1016/j.physio.2015.03.2157

Romero-Reyes, M., Arman, S., Teruel, A., Kumar, S., Hawkins, J., & Akerman, S. (2023). Pharmacological management of orofacial pain. Drugs, 83(14), 1269-1292. DOI: https://doi.org/10.1007/s40265-023-01927-z

Sari, Ü. S., Eroglu, M., Büyükşerbetçi, G., Tokucoglu, F., & Sahin, N. (2024). Positive effect of self-exercise following Botulinum toxin injection on the permanence of the recovery among the patients with HFS and BFS: A clinical trial. Medicine, 103(24), e38215. DOI: https://doi.org/10.1097/MD.0000000000038215

Serrera-Figallo, M. A., Ruiz-de-León-Hernández, G., Torres-Lagares, D., Castro-Araya, A., Torres-Ferrerosa, O., Hernández-Pacheco, E., & Gutierrez-Perez, J. L. (2020). Use of botulinum toxin in orofacial clinical practice. Toxins, 12(2), 112. DOI: https://doi.org/10.3390/toxins12020112

Shimada, A., Ishigaki, S., Matsuka, Y., Komiyama, O., Torisu, T., Oono, Y., ... & Sasaki, K. (2019). Effects of exercise therapy on painful temporomandibular disorders. Journal of oral rehabilitation, 46(5), 475-481. DOI: https://doi.org/10.1111/joor.12770

Small, R. (2014). Botulinum toxin injection for facial wrinkles. American family physician, 90(3), 168-175.

Sterne, J. A., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., ... & Higgins, J. P. (2016). ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. bmj, 355. DOI: https://doi.org/10.1136/bmj.i4919

von Piekartz, H., Bleiss, S., Herzer, S., Hall, T., & Ballenberger, N. (2024). Does combining oro‐facial manual therapy with bruxism neuroscience education affect pain and function in cases of awake bruxism? A pilot study. Journal of Oral Rehabilitation, 51(9), 1692-1700. DOI: https://doi.org/10.1111/joor.13740

Yoelin, S. G., Dhawan, S. S., Vitarella, D., Ahmad, W., Hasan, F., & Abushakra, S. (2018). Safety and efficacy of EB-001, a novel type E botulinum toxin, in subjects with glabellar frown lines: Results of a phase 2, randomized, placebo-controlled, ascending-dose study. Plastic and Reconstructive Surgery, 142(6), 847e-855e. DOI: https://doi.org/10.1097/PRS.0000000000005029

Zhang, L., Xu, L., Wu, D., Yu, C., Fan, S., & Cai, B. (2021). Effectiveness of exercise therapy versus occlusal splint therapy for the treatment of painful temporomandibular disorders: a systematic review and meta-analysis. Annals of palliative medicine, 10(6), 6122132-6126132. DOI: https://doi.org/10.21037/apm-21-451