Impact of Khat Chewing on the Clinical Outcomes of Autologous Blood Injection in Treating Bilateral TMJ Subluxation: A Case Series of 40 Patients
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Abstract
Background: Bilateral temporomandibular joint (TMJ) subluxation causes significant functional impairment, including difficulty chewing, speech problems, and malocclusion. Autologous blood injection (ABI) is a common minimally invasive treatment, but the influence of khat chewing—a prevalent habit in certain regions containing psychoactive compounds with sympathomimetic effects—on its clinical outcomes remains unexplored.
Objectives: This case series aimed to evaluate the association between khat chewing during treatment and the clinical success of ABI in patients with bilateral TMJ subluxation.
Methods: Forty consecutive patients (20 male, 20 female; aged 29 years [n=10 males], 33 years [n=10 females], 35 years [n=10 males], or 42 years [n=10 females]) with radiographically confirmed (orthopantomogram) bilateral TMJ subluxation received standardized ABI therapy (twice weekly for 3 weeks). Patients were categorized based on self-reported khat chewing during treatment. The primary outcome was treatment success, defined as resolution of symptoms (restored mastication, normal speech, corrected occlusion/deviation) and confirmed return of the joint to normal position on follow-up imaging.
Results: All 20 khat chewers (100%; male, aged 29 or 35 years) experienced treatment failure, exhibiting persistent symptoms and no joint reduction on imaging. In contrast, all 20 non-chewers (100%; female, aged 33 or 42 years) achieved treatment success, demonstrating marked symptomatic improvement and confirmed joint reduction (p < 0.0001, Fisher's Exact Test). Khat chewing status showed a perfect negative association with treatment success and was completely confounded with gender and specific age groups in this cohort.
Conclusion: Khat chewing during treatment demonstrated a profound negative association with the success of ABI for bilateral TMJ subluxation, resulting in universal treatment failure, while abstinence was associated with universal success. Khat chewing appears to be a critical negative prognostic factor, potentially negating the therapeutic effect of ABI. Patients undergoing ABI must be strongly advised to abstain from khat use. Further controlled studies are warranted to establish causality.
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Temporomandibular Joint (TMJ) Subluxation; Autologous Blood Injection (ABI); Khat Chewing; Catha edulis; Treatment Outcome; Treatment Failure; Prognostic Factor; Case Series.
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