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Chapter 12316Robiony(16) concluded that the use of BTX-A should be included in the physiotherapeutic treatment of patients who have had an ankylosed joint for a longer period because the temporalis and masseter muscles often have degenerated and shortened. By using BTX-A, relaxation of the masticatory muscles could be achieved together with an analgesic effect which, through physiotherapy, allowed for an elongation of the masticatory muscles. DiscussionThe TMJ and masticatory muscles can be affected by a wide array of disorders. As a result, this heterogeneous group of pathologies, better known as TMDs, is the most frequent cause of nonodontogenic orofacial pain. With many different epidemiological studies being conducted with different patient groups, the current literature estimates that 10% to 25% of the general population is subject to a TMD at any given point in time, with a 3:1 ratio of women to men and an onset of symptoms occurring mainly between the ages of 20 and 40 years.(17–21) Although most TMD are selflimiting, a meta-analysis by Al-Jundi et al(21) concluded that approximately 15.6% to 16.2% of all TMD patients are in need of professional treatment. To evaluate the severity of the TMD and the indicated therapy based on this diagnosis, several tools can be used, such as the staging classification for internal derangement of the TMJ by Wilkes and the Helkimo index.(22,23) The Helkimo index can be broken down into 3 sub-indices: anamnestic, clinical, and occlusal dysfunction. The anamnestic and occlusal subindexes have 3 different levels ranging from none to moderate or severe occlusal dysfunction or symptoms; the clinical dysfunction ranges from no dysfunction symptoms to mild, moderate or severe symptoms.(23) The Wilkes’ classification is based on clinical and radiological properties, as well as the anatomical appearance of the TMJ. The scale ranges from early stage internal derangement, recognizable by a click during opening of the mouth and a slight forward displacement of the disk, to early intermediate, intermediate, late intermediate, and latestage internal derangement. In case of the latter, perforations of the disk Nikolas de Meurechy NW.indd 316 05-06-2024 10:15