Despite the high prevalence of myofascial pain dysfunction (MPD) and the possibility of the occurrence of myofascial pain in any muscle of the human body including the orofacial region, we could find only two randomized controlled trials of three reports (McMillan 1997; Venancio 2009) that fitted our inclusion criteria for this systematic review. One study (McMillan 1997) compared local anaesthesia versus dry needling and measured the pain intensity on a VAS scale. Only pain score immediately showed insignificant difference between the two groups. And one study (Venancio 2009) had two different reports (Venancio 2009) as one report compared between local anaesthesia, dry needling and Botox and the other compared between local anaesthesia and dry needling. The two reports looked identical as they used the same pain scores in the local anaesthesia and dry needling groups, therefore they are merged into one study. It could not be used in the analysis because the author reported the pain intensity in index of three subscales and didn't report the primary results individually. Regarding the overall quality of the studies, the assessment showed that the methodological quality of the two studies and three reports included in this review was low. Overall completeness and applicability of evidence Two RCTs of three reports only included in this review; McMillan 1997 and Venancio 2009 which were relevant to the review question. Only Venancio 2009 was designed to test the effectiveness of the three interventions in treatment of MTRPs in the face in patients with headache. While McMillan 1997 tested only two intervention; dry needling and local anaesthesia in treatment of MTRPs of the face. The studies aim was relevant to our review objectives, to compare the effectiveness of local anaesthesia, Botox and dry needling in relieving pain in patients with MTRPs in the face (muscles of mastication). However they are insufficient to extrapolate the results on the population due to small number of participants, not all the three interventions are reported in one of the studies and also none of them reported all the relevant outcomes except pain and consequently impacts the external validity of the review.