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Vejbrink Kildal V, Rodriguez-Lorenzo A, Pruidze P, Reissig L, Weninger WJ, Tzou CHJ, Jonsson L, Meng S. Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors. Plast Reconstr Surg 2024; 153:617e-625e. [PMID: 37285208 DOI: 10.1097/prs.0000000000010802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Botulinum toxin injection is the accepted standard treatment for synkinesis and gustatory hyperlacrimation in patients with facial paralysis. However, poor injection accuracy can result in inconsistent treatment outcomes, variable treatment durations, and complications. Ultrasound guidance should increase injection accuracy in the facial region; however, this has not been proven. METHODS Twenty-six hemifaces of nonembalmed cadavers were studied in a randomized split-face manner. Ink was injected with ultrasound or landmark guidance into the lacrimal gland and three common synkinetic muscles: the orbicularis oculi, depressor anguli oris, and mentalis. Injection accuracy was evaluated using several measures. RESULTS Using ultrasound guidance, most ink (>50%) was found inside the correct target in 88% of cases, compared with 50% using landmark guidance ( P < 0.001). This was most pronounced in the lacrimal gland (62% versus 8%), depressor anguli oris (100% versus 46%), and mentalis (100% versus 54%) ( P < 0.05). All ink was found inside the correct target (no ink outside) in 65% using ultrasound guidance versus 29% without ( P < 0.001). Injection accuracy (any ink in target) was 100% when using ultrasound guidance versus 83% without ( P < 0.01). Twenty-three percent of the landmark-guided depressor anguli oris injections stained the facial artery ( P = 0.22). CONCLUSIONS Ultrasound guidance significantly increased injection accuracy and reduced the amount of ink lost in the surrounding tissue compared with landmark guidance. Clinical trials are needed to explore the effects of ultrasound guidance on treatment outcome, duration, and complications in patients with facial paralysis.
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Affiliation(s)
| | | | | | | | | | - Chieh-Han John Tzou
- Uppsala, Sweden; and Vienna, Austria
- From the Department of Surgical Sciences, Plastic and Maxillofacial Surgery
- Otorhinolaryngology-Head and Neck Surgery, Uppsala University
- Division of Anatomy, Medical University of Vienna
- BioImaging Austria (CMI)
- Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior (Krankenhaus Goettlicher Heiland)
- Faculty of Medicine, Sigmund Freud University
- Facial Palsy Center, Tzou Medical
- Radiology, Hanusch Hospital
| | - Lars Jonsson
- Otorhinolaryngology-Head and Neck Surgery, Uppsala University
| | - Stefan Meng
- Division of Anatomy, Medical University of Vienna
- Radiology, Hanusch Hospital
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O'Rourke SP, Miller MQ. Predicting Depressor Anguli Oris Excision Outcomes Using Local Muscle Block. Facial Plast Surg Aesthet Med 2022. [DOI: 10.1089/fpsam.2022.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Samuel P. O'Rourke
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Matthew Q. Miller
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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3
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Lacroix G, Duquennoy-Martinot V, Guerreschi P. Le muscle buccinateur : une nouvelle cible pour les injections de toxine botulique dans le traitement des séquelles de paralysie faciale. ANN CHIR PLAST ESTH 2022; 67:125-132. [DOI: 10.1016/j.anplas.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
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4
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David AP, Seth R, Knott PD. Facial Reanimation and Reconstruction of the Radical Parotidectomy. Facial Plast Surg Clin North Am 2021; 29:405-414. [PMID: 34217443 DOI: 10.1016/j.fsc.2021.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Radical parotidectomy may result from treating advanced parotid malignancies invading the facial nerve. Survival is often enhanced with multimodality treatment protocols, including postoperative radiation therapy. In addition to the reconstructive challenge of restoring facial nerve function, patients may be left with a significant cervicofacial concavity and inadequate skin coverage. This should be addressed with stable vascularized tissue that is resistant to radiation-induced atrophy. This article describes a comprehensive strategy, includes the use of the anterolateral thigh free flap, the temporalis regional muscle transfer, motor nerve to vastus lateralis grafts, nerve to masseter transfer, and fascia lata grafts for static suspension.
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Affiliation(s)
- Abel P David
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA 94115, USA
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA 94115, USA
| | - Philip Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA 94115, USA.
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5
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Adverse Events Associated With Botox as Reported in a Food and Drug Administration Database. Aesthetic Plast Surg 2021; 45:1201-1209. [PMID: 33128076 DOI: 10.1007/s00266-020-02027-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Botulinum toxin treatment is the most frequently performed noninvasive cosmetic procedure performed in the USA. Because of its widespread use, an analysis of the adverse event (AE) profile of Botox injections is needed. METHODS The FDA Adverse Event Report System was queried using an online web-based tool to determine the top 15 adverse events reported for four Botox brand names: Botox/Botox Cosmetic, Dysport, and Xeomin. The proportional reporting ratios (PRR) and relative odds ratios (ROR) were determined. A literature review was performed for eight AEs of clinical significance: eyelid/eyebrow ptosis, asthenia, muscular weakness, facial paresis, dysphagia, botulism, and death. RESULTS Botox/Botox Cosmetic had 38367 AEs. Dysport had 3582 AEs. Xeomin had 1405 AEs. All drugs with reported cases of eyelid and eyebrow ptosis had significant PRR and ROR values. The PRR and ROR values for asthenia were not significant in any of the drugs and only reached significance for Dysport for muscular weakness and dysphagia. Both Botox/Botox Cosmetic and Dysport had elevated PRRs and RORs for facial paresis and botulism. While all drugs had at least one reported case of death related to Botox injection use, none of the PRR or ROR values were significant. CONCLUSION Known AEs for Botox injection use include eyelid/brow ptosis and muscular weakness. Feared but rare complications of Botox injection use include dysphagia, botulism, and possibly death, owing to systemic spread of the toxin. This is the first study to analyze the AE data reported to the FDA on Botox injection use. EBM LEVEL III.
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Botulinum Toxin Type A to Improve Facial Symmetry in Facial Palsy: A Practical Guideline and Clinical Experience. Toxins (Basel) 2021; 13:toxins13020159. [PMID: 33670477 PMCID: PMC7923088 DOI: 10.3390/toxins13020159] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
Unilateral peripheral facial nerve palsy jeopardizes quality of life, rendering psychological consequences such as low self-esteem, social isolation, anxiety, and depression. Among therapeutical approaches, use of Botulinum toxin type A (BoNT-A) on the nonparalyzed side has shown promising results and improvement of quality of life. Nevertheless, the correct technique is paramount, since over-injection of the muscles can result in lack of function, leading to a "paralyzed" appearance, and even worse, functional incompetence, which may cause greater distress to patients. Therefore, the objective of this article is to provide a practical guideline for botulinum toxin use in facial palsy. To this aim, adequate patient assessment, BoNT-A choice, injection plan and dosage, and injection techniques are covered.
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Contralateral Facial Botulinum Toxin Injection in Cases with Acute Facial Paralysis May Improve the Functional Recovery: Where We Stand and the Future Direction. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.2.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Zhang H, Pendolino AL, Saeed SR, Andrews P. Botulinum Toxin Injection in Facial Paralysis and Other Neuromuscular Conditions. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00306-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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de Maio M. Myomodulation with Injectable Fillers: An Innovative Approach to Addressing Facial Muscle Movement. Aesthetic Plast Surg 2020; 44:1300-1316. [PMID: 32844271 DOI: 10.1007/s00266-020-01825-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/04/2018] [Indexed: 11/28/2022]
Abstract
Consideration of facial muscle dynamics is underappreciated among clinicians who provide injectable filler treatment. Injectable fillers are customarily used to fill static wrinkles, folds, and localized areas of volume loss, whereas neuromodulators are used to address excessive muscle movement. However, a more comprehensive understanding of the role of muscle function in facial appearance, taking into account biomechanical concepts such as the balance of activity among synergistic and antagonistic muscle groups, is critical to restoring facial appearance to that of a typical youthful individual with facial esthetic treatments. Failure to fully understand the effects of loss of support (due to aging or congenital structural deficiency) on muscle stability and interaction can result in inadequate or inappropriate treatment, producing an unnatural appearance. This article outlines these concepts to provide an innovative framework for an understanding of the role of muscle movement on facial appearance and presents cases that illustrate how modulation of muscle movement with injectable fillers can address structural deficiencies, rebalance abnormal muscle activity, and restore facial appearance.Level of Evidence V 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 .
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Affiliation(s)
- Maurício de Maio
- Clinica Dr. Maurício de Maio, Avenida Ibirapuera, 2907 cj 1202, São Paulo, SP, Moema EP: 04029200, Brazil.
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Miller MQ, Hadlock TA. Beyond Botox: Contemporary Management of Nonflaccid Facial Palsy. Facial Plast Surg Aesthet Med 2020; 22:65-70. [DOI: 10.1089/fpsam.2020.0009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew Q. Miller
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Tessa A. Hadlock
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
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11
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Labbé D, Guerreschi P. [Facial paralysis sequelae: Long term follow-up revision surgery, redo, continuing care]. ANN CHIR PLAST ESTH 2019; 64:531-539. [PMID: 31492441 DOI: 10.1016/j.anplas.2019.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022]
Abstract
Facial paralysis sequelae have an intense psycho-social impact which imposes an optimal care in the long run. The surgical challenges are numerous, and the therapeutic weapons are multiple. We propose an analysis of these treatments by the prism of their pitfalls and their limits. The complications of the main surgical procedures are described as well as the details of the rework necessary to cope with them or to quickly correct the defects. Moreover, the result limits are detailed with suggestions to improve them. Finally, we develop the necessary iterative treatments or new therapeutic proposals that are essential for the long-term care of these patients whose sequelae of facial paralysis evolve with time and aging. The surgery of facial paralysis is not unequivocal. It requires humility, patience and tenacity to support the patient throughout his life.
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Affiliation(s)
- D Labbé
- Hôpital privé Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - P Guerreschi
- Service de chirurgie plastique et reconstructrice, CHU de Lille, hôpital Roger Salengro, 59000 Lille, France.
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12
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Carvalho VF, Vieira APS, Paggiaro AO, Salles AG, Gemperli R. Evaluation of the body image of patients with facial palsy before and after the application of botulinum toxin. Int J Dermatol 2019; 58:1175-1183. [DOI: 10.1111/ijd.14414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 12/10/2018] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Andre O. Paggiaro
- Nursing Postgraduate Program of Guarulhos University Guarulhos Brazil
| | - Alessandra G. Salles
- Plastic Surgery Division Hospital das Clínicas Faculty of Medicine University of São Paulo Sao Paulo Brazil
| | - Rolf Gemperli
- Plastic Surgery Division Hospital das Clínicas Faculty of Medicine University of São Paulo Sao Paulo Brazil
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13
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Ursu D, Cederna PS. Discussion: Contralateral Botulinum Toxin Improved Functional Recovery after Tibial Nerve Repair in Rats. Plast Reconstr Surg 2018; 142:1520-1522. [PMID: 30489525 DOI: 10.1097/prs.0000000000005075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Daniel Ursu
- From the Section of Plastic Surgery and the Department of Biomedical Engineering, University of Michigan
| | - Paul S Cederna
- From the Section of Plastic Surgery and the Department of Biomedical Engineering, University of Michigan
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14
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Myomodulation with Injectable Fillers: An Innovative Approach to Addressing Facial Muscle Movement. Aesthetic Plast Surg 2018; 42:798-814. [PMID: 29549406 PMCID: PMC5945756 DOI: 10.1007/s00266-018-1116-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/04/2018] [Indexed: 11/02/2022]
Abstract
Consideration of facial muscle dynamics is underappreciated among clinicians who provide injectable filler treatment. Injectable fillers are customarily used to fill static wrinkles, folds, and localized areas of volume loss, whereas neuromodulators are used to address excessive muscle movement. However, a more comprehensive understanding of the role of muscle function in facial appearance, taking into account biomechanical concepts such as the balance of activity among synergistic and antagonistic muscle groups, is critical to restoring facial appearance to that of a typical youthful individual with facial esthetic treatments. Failure to fully understand the effects of loss of support (due to aging or congenital structural deficiency) on muscle stability and interaction can result in inadequate or inappropriate treatment, producing an unnatural appearance. This article outlines these concepts to provide an innovative framework for an understanding of the role of muscle movement on facial appearance and presents cases that illustrate how modulation of muscle movement with injectable fillers can address structural deficiencies, rebalance abnormal muscle activity, and restore facial appearance. LEVEL OF EVIDENCE V 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 .
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15
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Akulov MA, Orlova OR, Orlova AS, Usachev DJ, Shimansky VN, Tanjashin SV, Khatkova SE, Yunosha-Shanyavskaya AV. IncobotulinumtoxinA treatment of facial nerve palsy after neurosurgery. J Neurol Sci 2017; 381:130-134. [DOI: 10.1016/j.jns.2017.08.3244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/21/2017] [Accepted: 08/22/2017] [Indexed: 11/24/2022]
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Cooper L, Lui M, Nduka C. Botulinum toxin treatment for facial palsy: A systematic review. J Plast Reconstr Aesthet Surg 2017; 70:833-841. [DOI: 10.1016/j.bjps.2017.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 12/31/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
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Cabin JA, Massry GG, Azizzadeh B. Botulinum toxin in the management of facial paralysis. Curr Opin Otolaryngol Head Neck Surg 2016; 23:272-80. [PMID: 26101876 DOI: 10.1097/moo.0000000000000176] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Complete flaccid facial paralysis, as well as the synkinetic and hyperkinetic sequelae of partial recovery, has significant impact on quality of life. Patients suffer from functional deficiencies, cosmetic deformity, discomfort and social consequences leading to emotional distress. Despite an extensive and sophisticated array of available interventions for facial reanimation, most patients have persistent issues that require consistent follow-up. In long-term management, botulinum toxin (BT) injection remains a critical tool in the treatment of the facial paralysis patient, particularly in the case of synkinesis, hyperkinesis and imbalance. We review the recent scientific literature and highlight key principles and developments in the use of BT in the management of facial paralysis, including less common applications for acute facial paralysis, hyperlacrimation and pseudoptosis. RECENT FINDINGS We reviewed the literature for the latest advances in the use of BT in facial paralysis, including applications and technique, as well as measurement tools and adjunct exercises. We also share our experience in treating our own patient population. SUMMARY BT continues to be a well tolerated and effective tool in the long-term management of facial paralysis, specifically in treating synkinesis, imbalance and hyperkinesis, as well as hyperlacrimation and pseudoptosis. Consistent measurement tools and adjunct neuromuscular retraining are crucial in the successful deployment of BT. Controversy exists as to whether BT should be used to manage facial paralysis during the acute phase, and whether BT application to the nonparalyzed face can improve long-term recovery in the paralyzed side.
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Affiliation(s)
- Jonathan A Cabin
- aDepartment of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York bOphthalmic Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles cBeverly Hills Ophthalmic Plastic and Reconstructive Surgery dThe Facial Paralysis Institute, Beverly Hills eDepartment of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles fCenter for Advanced Facial Plastic Surgery, Beverly Hills, California, USA
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Risoud M, Aljudaibi N, Duquennoy-Martinot V, Guerreschi P. Long-term sequelae treatment of peripheral facial paralysis with botulinum toxin type A: Repartition and kinetics of doses used. ANN CHIR PLAST ESTH 2016; 61:10-5. [DOI: 10.1016/j.anplas.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/05/2015] [Indexed: 12/18/2022]
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19
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Mehdizadeh OB, Diels J, White WM. Botulinum Toxin in the Treatment of Facial Paralysis. Facial Plast Surg Clin North Am 2016; 24:11-20. [DOI: 10.1016/j.fsc.2015.09.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Botulinum Toxin Therapy versus Anterior Belly of Digastric Transfer in the Management of Marginal Mandibular Branch of the Facial Nerve Palsy: A Patient Satisfaction Survey. Arch Plast Surg 2015; 42:735-40. [PMID: 26618121 PMCID: PMC4659987 DOI: 10.5999/aps.2015.42.6.735] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 11/21/2022] Open
Abstract
Background Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy. Methods Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant. Results Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01). Conclusions BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.
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21
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Pucks N, Thomas A, Hallam MJ, Venables V, Neville C, Nduka C. Cutaneous cooling to manage botulinum toxin injection-associated pain in patients with facial palsy: A randomised controlled trial. J Plast Reconstr Aesthet Surg 2015; 68:1701-5. [PMID: 26385134 DOI: 10.1016/j.bjps.2015.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/21/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Botulinum toxin injections are an effective, well-established treatment to manage synkinesis secondary to chronic facial palsy, but they entail painful injections at multiple sites on the face up to four times per year. Cutaneous cooling has long been recognised to provide an analgesic effect for cutaneous procedures, but evidence to date has been anecdotal or weak. This randomised controlled trial aims to assess the analgesic efficacy of cutaneous cooling using a cold gel pack versus a room-temperature Control. MATERIAL AND METHODS The analgesic efficacy of a 1-min application of a Treatment cold (3-5 °C) gel pack versus a Control (room-temperature (20 °C)) gel pack prior to botulinum toxin injection into the platysma was assessed via visual analogue scale (VAS) ratings of pain before, during and after the procedure. RESULTS Thirty-five patients received both trial arms during two separate clinic appointments. Cold gel packs provided a statistically significant reduction in pain compared with a room-temperature Control (from 26.4- to 10.2-mm VAS improvement (p < 0.001)), with no variance noted secondary to age, the hemi-facial side injected or the order in which the Treatment or Control gel packs were applied. CONCLUSION Cryoanalgesia using a fridge-cooled gel pack provides an effective, safe and cheap method for reducing pain at the botulinum toxin injection site in patients with facial palsy.
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Affiliation(s)
- N Pucks
- Department of Acute General Medicine, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - A Thomas
- Division of Surgery, Imperial College London, 10th Floor QEQM Building, London, UK; Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK.
| | - M J Hallam
- Department of Plastic Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, UK
| | - V Venables
- Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK
| | - C Neville
- Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK
| | - C Nduka
- Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK
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Haykal S, Arad E, Bagher S, Lai C, Hohman M, Hadlock T, Zuker RM, Borschel GH. The Role of Botulinum Toxin A in the Establishment of Symmetry in Pediatric Paralysis of the Lower Lip. JAMA FACIAL PLAST SU 2015; 17:174-8. [DOI: 10.1001/jamafacial.2015.10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Siba Haykal
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ehud Arad
- Department of Plastic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaghayegh Bagher
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Lai
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Marc Hohman
- Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Boston
| | - Tessa Hadlock
- Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Boston
| | - Ronald M. Zuker
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gregory H. Borschel
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Lee JM, Choi KH, Lim BW, Kim MW, Kim J. Half-mirror biofeedback exercise in combination with three botulinum toxin A injections for long-lasting treatment of facial sequelae after facial paralysis. J Plast Reconstr Aesthet Surg 2014; 68:71-8. [PMID: 25444667 DOI: 10.1016/j.bjps.2014.08.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 08/12/2014] [Accepted: 08/24/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS The present study was conducted to develop a new method for maintaining the effect of botulinum toxin treatment for facial sequelae. We used a combination strategy including the administration of botulinum toxin three times at 6-8-month intervals followed by daily newly developed half-mirror biofeedback rehabilitation for about 2 years from the first injection. STUDY DESIGN This was a prospective study. METHODS Seventeen patients with unilateral facial palsy for >1 year were included in the study. The amount injected per site varied from 1.5 to 3 U. The purpose of the first injection was to reduce the most inconvenient facial problem such as facial synkinesis or hyperkinetic movement at the points of the periocular area and the zygomaticus major and minor muscles with an average dosage of 17.4 ± 13.9 U. The second injection was to enhance facial symmetry at prominent hypertrophic areas on the contralateral side with 36.5 ± 15.4 U, and the third injection was to add cosmetic configuration at the points of deep furrows and creases caused by facial muscular hyperkinesis or atrophy with 15.6 ± 8.4 U. RESULT After three injections of botulinum toxin A and 2 years of half-mirror biofeedback exercises, all patients showed marked relief of facial synkinesis and facial asymmetry. Before treatment, the mean ± standard deviation (SD) Sunnybrook (SB) score was 36.8 ± 8.76. After the first injection, the score increased by 11.4. After the second injection, the score increased by 14.6; it further increased by 15.6 after the third injection. CONCLUSION This facial rehabilitation strategy, consisting of three injections of botulinum toxin and half-mirror biofeedback exercises, proceeds over the course of 2 years and offers a long-lasting cure for facial synkinesis and facial symmetry as well as improved facial aesthetics.
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Affiliation(s)
- Jun Myung Lee
- Department of Otorhinolaryngology, Inje University College of Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Ki Hoon Choi
- Department of Otorhinolaryngology, Inje University College of Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Byung Woo Lim
- Department of Otorhinolaryngology, Inje University College of Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Myung Woo Kim
- Department of Otorhinolaryngology, Inje University College of Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jin Kim
- Department of Otorhinolaryngology, Inje University College of Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
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Mandavia R, Dessouky O, Dhar V, D'Souza A. The use of botulinum toxin in Otorhinolaryngology: an updated review. Clin Otolaryngol 2014; 39:203-9. [DOI: 10.1111/coa.12275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 11/26/2022]
Affiliation(s)
- R. Mandavia
- Academic Surgery; Northwest Thames Foundation School; London UK
| | - O. Dessouky
- Department of Otolaryngology; University Hospital Lewisham; London UK
| | - V. Dhar
- Department of Otolaryngology; University Hospital Lewisham; London UK
| | - A. D'Souza
- Department of Otolaryngology; University Hospital Lewisham; London UK
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Hexsel D, Dini TD. Advanced Botulinum Toxin Injections for Dynamic Rhytides: Treating the Upper Face, Lower Face, and Beyond. CURRENT DERMATOLOGY REPORTS 2014. [DOI: 10.1007/s13671-014-0075-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Orlova OR, Akulov MA, Usachev DI, Taniashin SV, Zakharov VO, Saksonova EV, Mingazova LR, Surovykh SV. [The use of botulinum toxin type a in the acute phase of facial nerve injury after neurosurgical surgery]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2014; 78:50-54. [PMID: 25809169 DOI: 10.17116/neiro201478650-54] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the role of botulinum toxin type A in the acute phase of facial nerve injury after neurosurgical surgery. MATERIALS AND METHODS The study involved 55 patients with acute facial muscle paresis caused by facial nerve injury during surgery on the posterior cranial fossa and cerebello-pontine angle (CPA). The first group consisted of 35 patients (mean age, 48.14±1.26 years) who were administered botulinum toxin type A (xeomin) at a dose of 2-3 U per point in muscles of the intact side of the face. The control group included 20 patients (mean age, 49.85±1.4 years) who underwent standard rehabilitation treatment of this pathology. The treatment efficacy was evaluated using the House-Brackmann Scale, the Yanagihara facial grading system, the Facial Disability Index (FDI), and the Sunnybrook Facial Grading (SFG) Scale. RESULTS Before treatment, patients of both groups experienced severe dysfunction according to the House-Brackmann Scale. A month after the botulinium toxin type A therapy had been started, a significant improvement in the group of patients who received botulinum toxin was observed at all scales (p<0.05), whereas improvement in the facial nerve function in the second group was observed only by the 3rd month of rehabilitation treatment (p<0.05). The number of synkineses in the patients who did not receive botulinum toxin was 46% higher than that in the first group (p=0.019) one year after the surgery, and it was higher by 91% after 2 years (p<0.001). CONCLUSIONS The use of botulinum toxin type A is reasonable in acute facial nerve injury and should be mandatory in combined therapy of these patients.
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Affiliation(s)
- O R Orlova
- GBOU VPO "Pervyĭ Moskovskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.I. Sechenova" Minzdrava Rossii, Moskva; Tsentr mezhdistsiplinarnoĭ stomatologii i nevrologii, Moskva
| | - M A Akulov
- FGBNU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva
| | - D Iu Usachev
- FGBNU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva
| | - S V Taniashin
- FGBNU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva
| | - V O Zakharov
- FGBNU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva
| | - E V Saksonova
- Tsentr mezhdistsiplinarnoĭ stomatologii i nevrologii, Moskva
| | - L R Mingazova
- Tsentr mezhdistsiplinarnoĭ stomatologii i nevrologii, Moskva
| | - S V Surovykh
- Tsentr mezhdistsiplinarnoĭ stomatologii i nevrologii, Moskva
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Contralateral botulinum toxin injection to improve facial asymmetry after acute facial paralysis. Otol Neurotol 2013; 34:319-24. [PMID: 23444480 DOI: 10.1097/mao.0b013e31827c9f58] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS The application of botulinum toxin to the healthy side of the face in patients with long-standing facial paralysis has been shown to be a minimally invasive technique that improves facial symmetry at rest and during facial motion, but our experience using botulinum toxin therapy for facial sequelae prompted the idea that botulinum toxin might be useful in acute cases of facial paralysis, leading to improve facial asymmetry. BACKGROUND In cases in which medical or surgical treatment options are limited because of existing medical problems or advanced age, most patients with acute facial palsy are advised to await spontaneous recovery or are informed that no effective intervention exists. The purpose of this study was to evaluate the effect of botulinum toxin treatment for facial asymmetry in 18 patients after acute facial palsy who could not be optimally treated by medical or surgical management because of severe medical or other problems. METHODS From 2009 to 2011, nine patients with Bell's palsy, 5 with herpes zoster oticus and 4 with traumatic facial palsy (10 men and 8 women; age range, 22-82 yr; mean, 50.8 yr) participated in this study. Botulinum toxin A (Botox; Allergan Incorporated, Irvine, CA, USA) was injected using a tuberculin syringe with a 27-gauge needle. The amount injected per site varied from 2.5 to 3 U, and the total dose used per patient was 32 to 68 U (mean, 47.5 +/- 8.4 U). RESULT After administration of a single dose of botulinum toxin A on the nonparalyzed side of 18 patients with acute facial paralysis, marked relief of facial asymmetry was observed in 8 patients within 1 month of injection. Decreased facial asymmetry and strengthened facial function on the paralyzed side led to an increased HB and SB grade within 6 months after injection. CONCLUSION Use of botulinum toxin after acute facial palsy cases is of great value. Such therapy decreases the relative hyperkinesis contralateral to the paralysis, leading to greater symmetric function. Especially in patients with medical problems that limit the medical or surgical treatment options, botulinum toxin therapy represents a useful alternative.
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Choi KH, Rho SH, Lee JM, Jeon JH, Park SY, Kim J. Botulinum toxin injection of both sides of the face to treat post-paralytic facial synkinesis. J Plast Reconstr Aesthet Surg 2013; 66:1058-63. [PMID: 23683725 DOI: 10.1016/j.bjps.2013.04.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 02/02/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE An attempt has been made to produce a new 'balance' in facial dynamics between a paralysed and a non-paralysed face with reduction of synkinesis, by concomitant injection of botulinum toxin A (BTX-A) on both sides in patients with long-lasting facial sequelae. STUDY DESIGN Prospective clinical study. SETTING University hospital. SUBJECTS AND METHODS Forty-two consecutive patients who recovered partially from facial nerve paralysis were enrolled for this study. The amount injected per site of the paralysed side with synkinesis varied from 1.5 to 2.5 U, and the total dose used per patient was 10-26 U (mean 17.12±5.3 U). That of the non-paralysed side with muscular hypertrophy varied from 2.5 to 5 U, and the total dose used per patient was 35-72 U (mean 52.6±9.7 U). All patients had been evaluated by the Sunnybrook (SB) facial nerve grading systems and developed dynamic facial asymmetry ratio. RESULTS After administration of injection of BTX-A on both sides of the face, relief of facial synkinesis and enhancement of facial symmetry were observed in all patients. Before the injection, the patients showed an SB score of 38.8±10.68. After the injection, changes of synkinesis and symmetry score were 7.9±1.81 and 8.4±3.25, respectively, resulting in a 58.4±12.46 score at the last evaluation. Before the administration, the mean±standard deviation (SD) value of dynamic facial asymmetry was 0.83±0.06 and it was increased significantly to 0.90±0.05 1 month after administration. CONCLUSION After BTX-A injection on both sides for synkinesis and contralateral hypertrophy, the patients showed significant suppression of the synkinesis and improvement of facial symmetry with resulting elevated quality of life, social interaction, personal appearance and food intake.
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Affiliation(s)
- Ki Hoon Choi
- Department of Otorhinolaryngology, Inje University College of Medicine, Ilsan Paik Hospital, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea
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Bhatnagar D, Conkling N, Rafailovich M, Phillips BT, Bui DT, Khan SU, Dagum AB. An in vivo analysis of the effect and duration of treatment with botulinum toxin type A using digital image speckle correlation. Skin Res Technol 2013; 19:220-9. [PMID: 23565582 DOI: 10.1111/srt.12010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Use of Botulinum toxin type A (BTX-A) for facial wrinkles is well-documented, but current methods of subjective evaluation by clinicians and patients fail to objectively quantify the magnitude and duration of facial muscle paralysis. OBJECTIVE (a) Determine the locus of facial muscular tension; (b) Quantify and monitor muscular paralysis and subsequent return; (c) Continuously correlate the appearance of wrinkles and muscular tension using non-invasive digital image speckle correlation (DISC) to measure treatment efficacy; (d) Corroborate objective data with existing rating scales (subject global assessment and facial lines outcome-11). METHODS Two sequential images of slight facial motion (frowning, raising eyebrows) are taken with a camera for n = 6 patients pre- and post-treatment at different time points up to 24 weeks. DISC processes the images to produce a vector map of muscular displacement to obtain spatially resolved information regarding facial tension. RESULTS We observed maximum paralysis (≥70%) at 2 weeks, and the rate of recovery varied widely ranging from 2 to 5 months, with two patients continuing to exhibit reduced contraction at 24 weeks. Vector analysis of pre-treatment contraction correctly predicted injection site and illustrated lines of maximum tension. CONCLUSIONS Digital image speckle correlation can precisely track the degree of contraction of different muscle groups following BTX-A injection. It can help predict injection site, quantify muscle paralysis, and monitor the recovery following BTX-A injection. Results were found to be reproducible across six patients.
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Affiliation(s)
- Divya Bhatnagar
- Department of Material Science and Engineering, Stony Brook University, Stony Brook, NY 11790, USA.
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Sadiq SA, Khwaja S, Saeed SR. Botulinum toxin to improve lower facial symmetry in facial nerve palsy. Eye (Lond) 2012; 26:1431-6. [PMID: 22975654 DOI: 10.1038/eye.2012.189] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION In long-standing facial palsy, muscles on the normal side overcontract causing difficulty in articulation, eating, drinking, cosmetic embarrassment, and psychological effects as patients lack confidence in public. METHODS We injected botulinum toxin A (BTXA) into the normal contralateral smile muscles to weaken them and restore symmetry to both active and passive movements by neutralising these overacting muscles. RESULTS A total of 14 patients received BTXA (79% women, median age 47 years, average length of palsy 8 years). They were all difficult cases graded between 2 and 6 (average grade 3 House-Brackmann). All 14 patients reported improved facial symmetry with BTXA (dose altered in some to achieve maximum benefit). Average dose was 30 units, but varied from 10 to 80 units. Average time to peak effect was 6 days; average duration of effect was 11 weeks. Three patients had increased drooling (resolved within a few days). CONCLUSION The improvement in symmetry was observed by both patient and examining doctor. Patients commented on increased confidence, being more likely to allow photographs taken of themselves, and families reported improved legibility of speech. Younger patients have more muscle tone than older patients; the effect is more noticeable and the benefit greater for them. BTXA improves symmetry in patients with facial palsy, is simple and acceptable, and provides approximately 4 months of benefit. The site of injection depends on the dynamics of the muscles in each individual patient.
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Affiliation(s)
- S A Sadiq
- Manchester Royal Eye Hospital, Manchester, UK.
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Habilitation of facial nerve dysfunction after resection of a vestibular schwannoma. Otolaryngol Clin North Am 2012; 45:513-30, xi. [PMID: 22483830 DOI: 10.1016/j.otc.2011.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Facial nerve dysfunction after resection of a vestibular schwannoma is one of the most common indications for facial nerve habilitation. This article presents an overview of common and emerging management options for facial habilitation following resection of a vestibular schwannoma. Immediate and delayed nerve repair options, as well as adjunctive surgical, medical, and physical therapies for facial nerve dysfunction, are discussed. Two algorithms are provided as guides for the assessment and treatment of facial nerve paralysis after resection of vestibular schwannoma.
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Labbé D, Bénichou L, Iodice A, Giot JP. Signe du Depressor Anguli Oris (DAO) dans les parésies faciales. Comment le rechercher et libérer le sourire (note technique). ANN CHIR PLAST ESTH 2012; 57:281-5. [DOI: 10.1016/j.anplas.2012.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 02/22/2012] [Indexed: 11/28/2022]
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Terzis JK, Karypidis D. Therapeutic strategies in post-facial paralysis synkinesis in pediatric patients. J Plast Reconstr Aesthet Surg 2012; 65:1009-18. [PMID: 22483723 DOI: 10.1016/j.bjps.2012.03.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 01/26/2012] [Accepted: 03/08/2012] [Indexed: 01/08/2023]
Abstract
UNLABELLED Synkinetic movements comprise abnormal involuntary contractions of one or more facial muscle groups which follow the desired contraction of another facial muscle group. They are frequently encountered in patients with long standing facial paralysis and seriously affect their psychological status due to the impairment of their facial appearance, function and emotional expressivity. PATIENTS AND METHODS Eleven pediatric patients (2 male and 9 female) presenting with post-facial paralysis synkinesis were included in the study. Mean age was 10.3±4 years and mean denervation time 72.5 months. RESULTS Patients underwent the following types of treatment: --Cross facial nerve grafting (CFNG) and secondary microcoaptations with botulinum toxin injection which had an improvement of 100% (3 in the 3 grade synkinesis scale) (n=2). --Cross facial nerve grafting (CFNG) and secondary microcoaptations without botulinum toxin injection which had an improvement of 66%(2 in the 3 grade synkinesis scale) (n=5). --CFNG and direct muscle neurotization with (n=2) or without (n=1) botulinum toxin injection where the improvement was 33%. --Contralateral nasalis muscle myectomy was performed in one patient along with CFNG and secondary microcoaptations which resulted in 66% synkinesis improvement. Biofeedback was invariably undertaken by all patients. Postoperative improvement in eye closure and smile was also noted in the respective cases treated for synkinesis ranging from 25 to 50%, with all patients achieving optimum functional return. CONCLUSION CFNG with secondary microcoaptations and botulinum toxin injections was found to be a very efficient surgical modality addressing post-facial palsy synkinesis with high improvement in facial function and symmetry. Facial neuromuscular re-education contributes considerably in the treatment.
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Affiliation(s)
- Julia K Terzis
- International Institute of Reconstructive Microsurgery, 27-28 Thomson Ave, Suite 620, Long Island City, NY 11101, USA.
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Kunert P, Smolarek B, Marchel A. Facial nerve damage following surgery for cerebellopontine angle tumours. Prevention and comprehensive treatment. Neurol Neurochir Pol 2012; 45:480-8. [PMID: 22127944 DOI: 10.1016/s0028-3843(14)60317-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Facial nerve (CN VII) palsy or even its transient paresis causes physical disability but is also a psychosocial problem. Immediately after vestibular schwannoma removal, different degrees of CN VII paresis occur in 20-70% of patients. Facial nerve paresis is observed in 10-40% after surgery of cerebellopontine angle meningiomas. Postoperative facial nerve weakness significantly reduces or completely withdraws with time in the majority of cases. However, even if prognosis for CN VII regeneration is good, proper management is needed because of the potential for serious ophthalmic complications. In this paper, the authors raise the issue of perioperative prophylaxis and comprehensive treatment of postoperative paresis of CN VII. Prophylaxis and treatment of ophthalmic complications are discussed. Current trends in the treatment of intraoperative loss of facial nerve continuity, management of facial paresis with good prognosis and dealing with facial palsy with no spontaneous recovery are also described in the paper.
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Affiliation(s)
- Przemysław Kunert
- Katedra i Klinika Neurochirurgii, Warszawski Uniwersytet Medyczny, ul. Banacha 1 A, Warszawa.
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Toffola ED, Furini F, Redaelli C, Prestifilippo E, Bejor M. Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy. Disabil Rehabil 2010; 32:1414-8. [PMID: 20156046 DOI: 10.3109/09638280903514697] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To assess the effect and efficacy of botulinum toxin type A (BTX-A) in reducing synkinesis in aberrant facial nerve regeneration (following facial paralysis). METHOD A total of 55 sessions of BTX-A (Botox) infiltration were performed on 30 patients (23 female) with synkinesis after facial palsy. Each subject was injected with 2.5 units of BTX-A in each injection site (the sites were chosen on a case-by-case basis). The synkinetic muscles targeted include: orbicularis oculi, zygomaticus major, depressor labii inferioris, platysma, healthy frontalis and healthy corrugator supercilii. The patients were examined using the Sunnybrook Facial Grading System, both before the BTX-A treatment and after an average of 35 days. RESULTS All 30 patients experienced improvement to the synkinesis after treatment. Total scores: median pre-BTX-A: 40; post 53 p = 0.004. Resting symmetry scores: mean pre-BTX-A -7.1; post: -3.5; median pre -5 [interquartile range (IQR) -10 to -5]; post: -5 (IQR -5 to 0); p = 0.0001. Symmetry of voluntary movement median pre-BTX-A: 56 post 60 p = 0.10. Synkinesis scores: median pre-BTX-A: -9 post -3 p < 0.0001. Mean duration of improvement was 4 months. CONCLUSIONS BTX-A injection treatment was effective in reducing facial synkinesis, thus improving facial expression symmetry both at rest and in voluntary movements.
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Affiliation(s)
- Elena Dalla Toffola
- Department of Physical Medicine and Rehabilitation, University of Pavia, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
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Salles AG, Toledo PN, Ferreira MC. Botulinum toxin injection in long-standing facial paralysis patients: improvement of facial symmetry observed up to 6 months. Aesthetic Plast Surg 2009; 33:582-90. [PMID: 19330369 DOI: 10.1007/s00266-009-9337-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 03/05/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite modern reanimation surgical techniques, facial paralysis presents with functional and aesthetic deficits. We evaluated facial symmetry after treating with botulinum toxin the healthy side of the face of 25 patients with long-standing facial paralysis who had previously been treated by surgical methods, with 6 months follow-up. METHODS Evaluation consisted of a clinical score, the two subscales of the Facial Disability Index, and surface electromyography. The mean botulinum toxin dose was 38 +/- 5 U (range = 15-69 U). RESULTS The clinical score showed significant reduction of asymmetry of 48.4% at 1 month and 16.8% after 6 months. The initial result was a consequence of reduced motion on the treated side combined with better motion on the paralyzed side. At 6 months, the treated side returned to basal scores. The residual effect seen in symmetry was due to an increase (18%) of motion in the paralyzed side. There was a significant decrease in the action potential of muscles on the nonparalyzed side 1 month post injection but completely reverted after 6 months. The Physical Function Index increased, but not significantly. The Social/Well-Being Function Index showed a significant increase at 6 months compared to pretreatment. CONCLUSION The proposed treatment improved facial symmetry for up to 6 months. Even after the end of the clinical effect of the drug, the paralyzed side's clinical score was 18% higher than pretreatment, with an increased quality of life.
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Abstract
Surgical intervention remains a popular choice in patients seeking facial rejuvenation. Although uncommon, temporary or permanent peripheral nerve injury may complicate almost any type of invasive aesthetic procedure of the face, resulting in functional and psychological consequences for patients. Prompt recognition and appropriate intervention are necessary to avoid the long-term sequelae and improve the chances of complete neurologic recovery. Depending on the type of injury, various interventions may range from observation and close follow-up to interposition nerve grafting. This article reviews the pertinent anatomy of nerves at risk in facial cosmetic surgery and discusses various management strategies for inadvertent injury to peripheral nerves of the face.
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de Maio M. Therapeutic uses of botulinum toxin: from facial palsy to autonomic disorders. Expert Opin Biol Ther 2008; 8:791-8. [PMID: 18476790 DOI: 10.1517/14712598.8.6.791] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The therapeutic uses of botulinum toxin have been expanding due to deeper knowledge of its molecular behaviour and different mechanisms of action. OBJECTIVE To present suggested doses of Botox and Dysport for controlling the muscle hyperkinetic activity in facial palsy in the perioral area and to review other uses. METHODS An extensive updated literature review on the success and limits of the botulinum neurotoxin (BoNT) therapeutic treatments. RESULTS/CONCLUSION BoNT can be considered to be the preferred single method for many disorders; it has substituted for some conventional surgical methods and it can be associated with other therapies to increase overall treatment performance. Depending on the disorder, the lack of permanent effect causes no major inconvenience.
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Affiliation(s)
- Maurício de Maio
- Avenida Ibirapuera, 2907 cj 1202 CEP: 04029-200, Moema, São Paulo, Brazil.
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Rhee JS, McMullin BT. Outcome measures in facial plastic surgery: patient-reported and clinical efficacy measures. ACTA ACUST UNITED AC 2008; 10:194-207. [PMID: 18490547 DOI: 10.1001/archfaci.10.3.194] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To survey the existing literature to identify, summarize, and evaluate procedure- and condition-specific outcome measures for use in facial plastic and reconstructive surgery. METHODS A review of the English-language literature was performed to identify outcomes instruments specific for targeted facial plastic surgery interventions and conditions. A search was performed using MEDLINE (1950 to September 2007), CINAHL (Cumulative Index to Nursing & Allied Health) (1982 to September 2007), and PsychINFO (1806 to September 2007). Outcomes instruments were categorized as patient-reported or clinical efficacy measures (observer-reported or objective measures). Instruments were then categorized to include relevant details on the intervention, degree of validation, and subsequent use. RESULTS Sixty-eight distinct instruments were identified (23 patient-reported, 35 observer-reported, and 10 objective measures), with some overlap among categories. Most patient-reported measures (76%) and half observer-reported instruments (51%) were developed in the past 10 years. The rigor of validation varied widely among measures, with formal validation being most common among the patient-reported outcome measures. CONCLUSIONS Validated outcomes measures are present for many common facial plastic surgery conditions and have become more prevalent during the past decade, especially for patient-reported outcomes. Challenges remain in harmonizing patient-reported, observer-based, and other objective measures to produce standardized clinically meaningful outcome measures.
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Affiliation(s)
- John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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