1
|
Guarda Nardini L, Manfredini D, Colonna A, Ferrari Cagidiaco E, Ferrari M, Val M. Intramuscular Botulinum Toxin as an Adjunct to Arthrocentesis with Viscosupplementation in Temporomandibular Disorders: A Proof-of-Concept Case-Control Investigation. Toxins (Basel) 2024; 16:364. [PMID: 39195774 PMCID: PMC11359951 DOI: 10.3390/toxins16080364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/04/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND The reduction in joint load is a potential beneficial factor in managing osteoarthritis of the temporomandibular joint (TMJ). This paper aims to compare the effectiveness of the intramuscular injection of botulinum toxin (BTX-A) as an adjunct to TMJ arthrocentesis plus viscosupplementation with arthrocentesis plus viscosupplementation alone in the management of TMJ osteoarthritis. METHODS A pilot clinical retrospective study examined TMJ osteoarthritis treatments. Patients were divided into two groups: Group A received BTX-A injections and arthrocentesis with viscosupplementation, while Group B received only arthrocentesis with viscosupplementation. The study assessed outcomes based on mouth opening (MO), pain at rest (PR), pain at mastication (PF), and masticatory efficiency (ME) at various time points (baseline (T0), 1 week (T1), 2 weeks (T2), 3 weeks (T3), and 4 weeks (T4)) up to 2 months after treatment. RESULTS The study included two groups, each with five patients. Group A received five weekly sessions of arthrocentesis plus viscosupplementation and a single BTX-A injection during the first arthrocentesis appointment. Group B underwent the five-session protocol of arthrocentesis plus viscosupplementation alone. MO, PF, PR, and ME improved quickly in T2 in both groups, but the improvement was of greater importance over the following weeks and lasted longer in Group A. CONCLUSIONS Arthrocentesis with viscosupplementation associated with BTX-A was found to be more effective than arthrocentesis alone in improving clinical outcomes. This suggests that patients with TMJ osteoarthritis and myofascial pain may benefit from reduced muscle tone and joint load.
Collapse
Affiliation(s)
- Luca Guarda Nardini
- Unit of Oral and Maxillofacial Surgery, Ca’Foncello Hospital, ASL 2 Marca Trevigiana, 31100 Treviso, Italy
| | - Daniele Manfredini
- Department of Medical Biotechnologies, School of Dentistry, University of Siena, 53100 Siena, Italy
| | - Anna Colonna
- Department of Medical Biotechnologies, School of Dentistry, University of Siena, 53100 Siena, Italy
| | | | - Marco Ferrari
- Department of Medical Biotechnologies, School of Dentistry, University of Siena, 53100 Siena, Italy
| | - Matteo Val
- Department of Medical Biotechnologies, School of Dentistry, University of Siena, 53100 Siena, Italy
| |
Collapse
|
2
|
Wan J, Kim JS, Park Y, Park SY, Koppert E, Kim HJ, Yi KH. Novel single-entry point injection technique for masseter hypertrophy treatment using botulinum neurotoxin based on patient-reported comfort. J Cosmet Dermatol 2024. [PMID: 39005194 DOI: 10.1111/jocd.16461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/26/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Botulinum neurotoxin (BoNT) injections are widely used for the treatment of masseter muscle hypertrophy in Southeast Asia. However, there remains a lack of consensus regarding the optimal injection technique. This study aimed to compare the efficacy and patient discomfort associated with single-entry point injections versus multiple three-point injections for masseter muscle hypertrophy treatment with BoNT. MATERIALS AND METHODS Sixteen participants, comprising both male and female Korean adults aged 22-63, were enrolled in the study. On the left side of the face, single-entry point injections were administered, followed by multidirectional injections, while on the right side, three-point injections were given. Pain intensity during the procedure was assessed using visual analogue scale scores. RESULT Our results revealed that participants experienced lower levels of pain with single-entry point injections compared to three-point injections (average visual analogue scores of 3.31 and 5.19, respectively). CONCLUSION These findings highlight the potential benefits of single-entry point injections in reducing patient discomfort during masseter muscle hypertrophy treatment with BoNT. We advocate for further research to validate these findings and encourage practitioners to consider single-entry point injections as a viable option for enhancing treatment outcomes in their clinical practice.
Collapse
Affiliation(s)
- Jovian Wan
- Asia Pacific Aesthetic Academy, Hong Kong, Hong Kong
| | - Jong-Seo Kim
- Kimjongseo Plastic Surgery Clinic, Seoul, South Korea
| | | | - Soo Yeon Park
- Made-Young Plastic Surgery Clinic, Seoul, South Korea
| | - Erik Koppert
- Department of Surgery, Epworth Hawthorn and Epworth Eastern Private Hospitals, Melbourne, Victoria, Australia
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
- Maylin Clinic (Apgujeong), Seoul, South Korea
| |
Collapse
|
3
|
de Souza Nobre BB, Rezende L, Barbosa Câmara-Souza M, Sanchez-Ayala A, Blass R, Carbone AC, Manso AC, Ernberg M, Christidis N, De la Torre Canales G. Exploring botulinum toxin's impact on masseter hypertrophy: a randomized, triple-blinded clinical trial. Sci Rep 2024; 14:14522. [PMID: 38914688 PMCID: PMC11196657 DOI: 10.1038/s41598-024-65395-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
The present study aimed to assess the effectiveness and functional adverse effects of a single and multiple injections of botulinum toxin A (BoNT-A) for masseter hypertrophy (MH). Twenty-six women complaining about lower third facial enlargement due to MH, received 75 U of BoNT-A (abobotulinum toxin) in each masseter muscles. After 3 months, patients were randomly assigned to receive a second treatment session of Saline Solution: (G1; n = 11) or BoNT-A: (G2; n = 12). Muscle thickness (ultrasound), electrical activity (electromyography; EMG), masticatory performance, and subjective perception of MH were evaluated. Follow-up was performed at 1, 3 and 6 months. Muscle thickness, EMG activity, and masticatory performance were analyzed using ANOVA two-way and Sidak test as post-hoc. Masticatory performance was analyzed by the Friedman's test and Mann-Whitney test. Regarding inter-groups comparisons, there was a significant decrease in the left masseter muscle thickness in the G2 group at the 6 month follow-up (p < 0.02). For EMG, significant differences were evident at the 6 month assessment, with higher masseter activity for G1 (p < 0.05). For masticatory performance, no significant differences were observed throughout the study (p > 0.05) and a higher improvement in subjective perception of MH was observed in the 1 month follow-up for G2 (p < 0.05). In conclusion, BoNT-A is effective for MH, however multiple injections cause functional adverse effects in masseter muscle.
Collapse
Affiliation(s)
| | - Luciana Rezende
- Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil
| | | | | | | | | | - Ana Cristina Manso
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal
| | - Malin Ernberg
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), 14104, Huddinge, Sweden
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), 14104, Huddinge, Sweden
| | - Giancarlo De la Torre Canales
- Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil.
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal.
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), 14104, Huddinge, Sweden.
| |
Collapse
|
4
|
de Souza Nobre BB, de Oliveira Resende Machado L, Poluha RL, Câmara-Souza MB, Carbone AC, de Almeida AM, Grigoriadis A, Kumar A, De la Torre Canales G. Temporalis Muscle Changes Following Botulinum Toxin A Injections in Masseter Hypertrophy Patients: A Randomized Triple-Blinded Trial. Aesthetic Plast Surg 2024:10.1007/s00266-024-04064-4. [PMID: 38740627 DOI: 10.1007/s00266-024-04064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND This study aimed to elucidate the effects of botulinum toxin A (BoNT-A) treatment for patients diagnosed with masseter hypertrophy on the temporalis muscle, with a particular focus on assessing alterations in muscle thickness, electromyographic (EMG) activity, and the development of muscle pain. METHODS The present randomized triple-blinded clinical trial enrolled 26 female participants aged between 25 and 50 years complaining about masseter hypertrophy. Participants received 75U of BoNT-A (abobotulinumtoxinA) in both masseter muscles and after three months were randomized to receive a second treatment session of saline solution (S-BoNT-A) or BoNT-A (M-BoNT-A). Longitudinal assessments included temporalis muscle thickness through ultrasound, EMG activity, subjective pain, and masseter prominence severity after one, three, and six months of the first injection session. Muscle thickness, EMG, and subjective pain were analysed using two-way ANOVA with repeated measures and post hoc Sidak test, and for masseter prominence severity, Friedman and Mann-Whitney tests were used. RESULTS Regarding inter-group comparisons, a higher muscle thickness (p < 0.02) and a higher EMG activity (p < 0.01) were found in the M-BoNT-A group at the 6-month follow-up. For subjective pain assessments, inter-group comparisons showed a higher prevalence of painful regions in M-BoNT-A group at the 6-month follow-up (p < 0.02). No significant differences were found in masseter prominence severity at the 6 months assessment between groups. CONCLUSION BoNT-A treatment for masseter hypertrophy lead to structural and functional changes in the temporalis muscle, presenting higher changes after multiple injections of this treatment. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
| | | | | | | | | | - Andre Mariz de Almeida
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, Almada, Portugal
| | - Anastasios Grigoriadis
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, Stockholm, Sweden
| | - Abhishek Kumar
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, Stockholm, Sweden
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
| | - Giancarlo De la Torre Canales
- Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil.
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, Almada, Portugal.
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, Stockholm, Sweden.
| |
Collapse
|
5
|
Koh YG, Shin SH, Kim KR, Yeoum SH, Choi WW, Park KY. A Double-Blinded, Randomized, Dose-Comparison Pilot Study to Comparatively Evaluate Efficacy and Safety of Two Doses of Botulinum Toxin Type A Injection for Deltoid Muscle Hypertrophy. Ann Dermatol 2023; 35:355-359. [PMID: 37830417 PMCID: PMC10579568 DOI: 10.5021/ad.22.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 04/25/2023] [Accepted: 05/10/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Botulinum toxin type A (BTX-A) injection is being widely used off-label for muscular hypertrophy, including deltoid muscle hypertrophy. However, very few studies have evaluated the optimal dosage and its clinical response. OBJECTIVE This study aimed to assess the efficacy and safety of different doses of Prabotulinum toxin A (PBoNT) for treating deltoid muscle hypertrophy. METHODS Twelve particiapants with bilateral deltoid muscle hypertrophy were enrolled and randomly received either 16 U or 32 U of PBoNT. In each participant, the same dose was administered to both deltoid muscles. Both participants and evaluators were blinded. Deltoid muscle thickness and upper arm circumference were measured on day 0, and weeks 2, 4, and 12 after the PBoNT injection. RESULTS Upper arm circumference significantly decreased in both groups; however, deltoid muscle thickness was reduced in the 16 U group only. No major complications were reported in both groups. However, a few minor complications were reported in the 16 U injection group. CONCLUSION Both 16 U and 32 U of PBoNT intramuscular injections are safe and effective in treating deltoid hypertrophy.
Collapse
Affiliation(s)
- Young Gue Koh
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sun Hye Shin
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ka Ram Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | | | | | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea.
| |
Collapse
|
6
|
Balanta-Melo J, Eyquem-Reyes A, Blanco N, Vásquez W, Kupczik K, Toro-Ibacache V, Buvinic S. Unilateral Hypofunction of the Masseter Leads to Molecular and 3D Morphometric Signs of Atrophy in Ipsilateral Agonist Masticatory Muscles in Adult Mice. Int J Mol Sci 2023; 24:14740. [PMID: 37834190 PMCID: PMC10572689 DOI: 10.3390/ijms241914740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Mice are commonly used to study mandibular dynamics due to their similarity in chewing cycle patterns with humans. Adult mice treated unilaterally with botulinum toxin type A (BoNTA) in the masseter exhibit atrophy of this muscle characterized by an increase in the gene expression of atrophy-related molecular markers, and a reduction in both muscle fiber diameter and muscle mass at 14d. However, the impact of this muscle imbalance on the non-treated masticatory muscles remains unexplored. Here, we hypothesize that the unilateral masseter hypofunction leads to molecular and 3D morphometric signs of atrophy of the masseter and its agonist masticatory muscles in adult mice. Twenty-three 8-week-old male BALB/c mice received a single injection of BoNTA in the right masseter, whereas the left masseter received the same volume of saline solution (control side). Animals were euthanized at 2d, 7d, and 14d, and the masticatory muscles were analyzed for mRNA expression. Five heads were harvested at 14d, fixed, stained with a contrast-enhanced agent, and scanned using X-ray microtomography. The three-dimensional morphometric parameters (the volume and thickness) from muscles in situ were obtained. Atrogin-1/MAFbx, MuRF-1, and Myogenin mRNA gene expression were significantly increased at 2 and 7d for both the masseter and temporalis from the BoNTA side. For medial pterygoid, increased mRNA gene expression was found at 7d for Atrogin-1/MAFbx and at 2d-7d for Myogenin. Both the volume and thickness of the masseter, temporalis, and medial pterygoid muscles from the BoNTA side were significantly reduced at 14d. In contrast, the lateral pterygoid from the BoNTA side showed a significant increase in volume at 14d. Therefore, the unilateral hypofunction of the masseter leads to molecular and morphological signs of atrophy in both the BoNTA-injected muscle and its agonistic non-injected masticatory muscles. The generalized effect on the mouse masticatory apparatus when one of its components is intervened suggests the need for more clinical studies to determine the safety of BoNTA usage in clinical dentistry.
Collapse
Affiliation(s)
- Julián Balanta-Melo
- School of Dentistry, Faculty of Health, Universidad del Valle, Cali 760043, Colombia;
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Indiana Center for Musculoskeletal Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Andrea Eyquem-Reyes
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (A.E.-R.); (N.B.); (W.V.); (V.T.-I.)
| | - Noelia Blanco
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (A.E.-R.); (N.B.); (W.V.); (V.T.-I.)
| | - Walter Vásquez
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (A.E.-R.); (N.B.); (W.V.); (V.T.-I.)
| | - Kornelius Kupczik
- Department of Anthropology, Faculty of Social Sciences, Universidad de Chile, Santiago 7750000, Chile
- Max Planck Institute for Evolutionary Anthropology, 04103 Leipzig, Germany
| | - Viviana Toro-Ibacache
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (A.E.-R.); (N.B.); (W.V.); (V.T.-I.)
| | - Sonja Buvinic
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (A.E.-R.); (N.B.); (W.V.); (V.T.-I.)
- Center for Exercise, Metabolism and Cancer Studies CEMC2016, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
| |
Collapse
|
7
|
Jung BK, Park H, Cheon YW, Yun IS, Choi JW, Kim HJ, Lee MY, Kang BS, Kang TJ. Clinical investigation of botulinum toxin (prabotulinumtoxin A) for bruxism related to masseter muscle hypertrophy: A prospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00076-8. [PMID: 37353404 DOI: 10.1016/j.jcms.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/22/2023] [Accepted: 05/21/2023] [Indexed: 06/25/2023] Open
Abstract
This study aims to confirm the effectiveness and safety of a prabotulinumtoxin type A (praBTX-A) injection in patients with bruxism and masseter hypertrophy. The study included patients who ground or clenched their teeth while sleeping and had computed tomography (CT) scans that showed a maximum thickness of the masseter muscle of 15 mm or more. The praBTX-A was administered bilaterally into the masseter muscles; 15 U/side for group 1, 25 U/side for group 2, and 35 U/side for group 3. CT scans and bruxism questionnaires were conducted before and eight weeks after the injection. Thirty-seven patients were enrolled, but three dropped out due to loss of follow-up. After injection, masseter thickness decreased to 15.1 ± 2.0 mm for group 1, 14.3 ± 2.9 mm for group 2, and 13.4 ± 1.8 mm for group 3 (p = 0.043). Group 3 showed a statistically significant lower masseter thickness compared to group 1 (p = 0.039). Both subjective and objective frequencies of bruxism decreased for all groups, but there were no significant differences in either subjective (p = 0.396) or objective frequencies (p = 0.87) between the groups after the injection. The results of this study suggest that praBTX-A injection is a safe and effective treatment for bruxism and masseter hypertrophy. A dosage of 35 IU/side can effectively decrease masseter thickness and relieve bruxism symptoms. Even the minimum dosage of 15 IU/side can contribute to improvements in bruxism symptoms. This investigation provides valuable information for managing bruxism that is associated with hypertrophic masseter muscles.
Collapse
Affiliation(s)
- Bok Ki Jung
- Department of Plastic and Reconstructive Surgery, University of Yonsei College of Medicine, Gangnam Severance Hospital, Republic of Korea
| | - Hojin Park
- Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Young Woo Cheon
- Departments of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University, College of Medicine, Incheon, Republic of Korea
| | - In Sik Yun
- Department of Plastic and Reconstructive Surgery, University of Yonsei College of Medicine, Gangnam Severance Hospital, Republic of Korea.
| | - Jong-Woo Choi
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Han Jo Kim
- Eight Plastic Surgery, Seoul, Republic of Korea
| | | | | | - Tae Jo Kang
- Yujin Esthetic Surgical Clinic, Seoul, Republic of Korea
| |
Collapse
|
8
|
Ferri A, Zito F, Menapace G, Zannoni C, Bergonzani M, Perlangeli G, Bianchi B. Optimizing the results of facial animation surgery: Botulinum toxin injection into free functional gracilis flap transfer. J Plast Reconstr Aesthet Surg 2023; 83:415-422. [PMID: 37307620 DOI: 10.1016/j.bjps.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/22/2023] [Accepted: 04/08/2023] [Indexed: 06/14/2023]
Abstract
Although neuromuscular gracilis transplantation is the best choice for facial reanimation in patients with congenital or inveterate palsy, the results are not completely satisfactory. Ancillary procedures developed to achieve better symmetry of the smile and reduce the hypercontractility of the transplanted muscle have been reported. However, the intramuscular injection of botulinum toxin has not been described for this purpose. Patients undergoing gracilis injections of botulinum toxin after facial reanimation surgery between September 1, 2020, and June 1, 2022, were retrospectively enrolled in this study. We collected photographs taken before and 20-30 days after injection and compared the symmetry of the face using software. Nine patients with a mean age of 23.56 years (range, 7-56 years) were enrolled. Reinnervation of the muscle was provided by the contralateral healthy facial nerve via a sural cross-graft (four patients), by the ipsilateral masseteric nerve (three cases), and by the contralateral masseteric and facial nerve (two). Using Emotrics software, we identified differences in the commissure excursion discrepancy of 3.82 mm, the smile angle discrepancy of 0.084°, and the dental show discrepancy of 1.49 mm; the average difference in the commissure height deviation was 2.26 mm (P = 0.02), and those in the upper- and lower-lip height deviation were 1.05 mm and 1.49 mm, respectively. Gracilis injection of botulinum toxin after gracilis transplantation is a safe and feasible procedure that could be applicable to all patients with asymmetric smiles related to excessive transplant contraction. It yields good esthetic results with little to no related morbidity.
Collapse
Affiliation(s)
- Andrea Ferri
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Francesca Zito
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy.
| | - Giorgia Menapace
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Cecilia Zannoni
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Michela Bergonzani
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Giuseppe Perlangeli
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Bernardo Bianchi
- Operative Unite of Maxillo-facial Surgery, Hospital of Genova, Parma, Italy
| |
Collapse
|
9
|
Rathod NN, John RS. Botulinum Toxin Injection for Masseteric Hypertrophy Using 6 Point Injection Technique - A Case Report. Proposal of a Clinical Technique to Quantify Prognosis. Clin Cosmet Investig Dent 2023; 15:45-49. [PMID: 36974260 PMCID: PMC10039629 DOI: 10.2147/ccide.s396057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Masseter hypertrophy presents as unilateral or bilateral swellings over the ramus and angle of the mandible. It is caused by malocclusion, clenching, TMJ disorders, etc and alters facial symmetry, leading to discomfort and negative cosmetic impact in many patients, making this a popular request for aesthetic and functional correction. Materials and Methods This case report involves injecting Botulinum toxin into 6 equidistant bulging points on the masseter. Standardized photography and clinical parameters were used to assess facial contour and masseter muscle thickness at baseline and successive follow ups. Results and Discussion Significant masseteric bulk reduction was observed in subsequent follow ups. Conclusion The 6-point technique was found to be an effective treatment modality for Botox injection in masseteric hypertrophy. The clinical method to quantify prognosis was easy and economical.
Collapse
Affiliation(s)
- Neha N Rathod
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, 600077, India
| | - Rubin S John
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, 600077, India
- Correspondence: Rubin S John, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, 600077, India, Email
| |
Collapse
|
10
|
Long-Term Effects of a Single Application of Botulinum Toxin Type A in Temporomandibular Myofascial Pain Patients: A Controlled Clinical Trial. Toxins (Basel) 2022; 14:toxins14110741. [PMID: 36355991 PMCID: PMC9721314 DOI: 10.3390/toxins14110741] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 01/26/2023] Open
Abstract
This study assessed the long-term effects of botulinum toxin type A (BoNT-A) in subjective pain, pain sensibility, and muscle thickness in persistent myofascial temporomandibular-disorder pain (MFP-TMD) patients. Fourteen female subjects with persistent MFP received BoNT-A treatment with different doses (10U-25U for temporalis muscle and 30U-75U for masseter muscle). The treatment was injected bilaterally in the masseter and anterior temporalis muscles in a single session. Clinical measurements included: self-perceived pain (VAS), pain sensibility (PPT), and muscles thickness (ultrasonography). Follow-up occurred 1, 3, 6, and 72 months after treatment for VAS and PPT and 1, 3, and 72 months for ultrasonography. For statistical analysis, the Friedman test with the Bonferroni test for multiple comparisons as a post hoc test was used for non-parametric repeated measures comparisons among the evaluation times. A 5% probability level was considered significant in all tests. VAS values presented a significant decrease throughout the study (p < 0.05). Regarding PPT values, a significant increase was found when comparing baseline data with post-treatment follow-ups (p < 0.05), and even though a significant decrease was found in muscle thickness when baseline values were compared with the 1- and 3-months assessments, no differences were found when compared with the 72 months follow-up (p > 0.05). A single injection of BoNT-A presents long-term effects in reducing pain in persistent MFP-TMD patients, and a reversibility of adverse effects on masticatory-muscle thickness.
Collapse
|