Do you typically consider Botox for patients with TMJ?

I do a fair number of Botox injections for TMJ (only small doses (5 to 7.5 units) when using Botox for migraines. Patients do report that it is helpful.

I also do this, by adding 1-2 injections in each masseter. 5-10 units per site. Works really well though I generally have to back down the dose eventually due to muscle atrophy.

In refractory cases, I have had clinical success with injecting the superficial temporalis muscles using 5 units per site given 1-3 sites per side. I tend to inject into the part of the muscle that is most active when the patient bites down. This, of course, is in addition to the injection of the masseters.

The preferred terminology is TMD as opposed to TMJ. I have found botulinum toxin much more effective for the treatment of TMD than for chronic migraine, with the benefit that can last 3-6 months or even longer. For TMD, it can be used by itself or, better, in combination with appliance therapy to prevent bruxism and preserve the structure of the teeth. I generally inject 15-30 units in each masseter muscle, palpating for taut bands that I inject. With botulinum toxin treatment of chronic migrain...