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Homma T, Uemura N, Tanaka K, Mori H, Okazaki M. Objective Assessment of the Repeated Botox Treatment to the Synkinesis of Facial Paralysis by the Integrated Electromyography. J Craniofac Surg 2024:00001665-990000000-01278. [PMID: 38231192 DOI: 10.1097/scs.0000000000009932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/07/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The widely used botox type A (BTX-A) is effective against synkinesis in facial palsy sequelae. Repeated injections are necessary and permanent improvements have been reported. We objectively evaluated the changes in synkinesis at >6 months after BTX-A injection, including changes over time with the number of administrations. METHODS In 48 patients who received multiple BTX-A injections, evaluation by the Sunnybrook Facial Grading System (FGS) and integrated electromyography (iEMG) was performed before treatment and at least 6 months after the first, second, and third BTX-A injection. The iEMG ratio on the affected and healthy sides was calculated for each mimetic muscle and mimic motion. RESULTS There was no significant difference in the FGS synkinesis score before treatment and after the third injection, although an improvement was observed. The iEMG ratio was significantly improved in the orbicularis oculi with open-mouth smile and lip pucker after the third dose compared to before treatment. The orbicularis oris showed a significant improvement when the eyelids were closed, while the platysma showed a significant improvement when the eyelids were closed and when the lip was pursed. Multiple regression analysis revealed that the orbicularis oculi and platysma had a greater effect on the iEMG ratio for the number of treatments than other factors. CONCLUSIONS Repeated BTX-A injections showed improvements in synkinesis for the orbicularis oculi, orbicularis oris, and platysma, even after >6 months, compared to before treatment.
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Affiliation(s)
- Tsutomu Homma
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University
| | - Noriko Uemura
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University
| | - Kentaro Tanaka
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University
| | - Hiroki Mori
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University
| | - Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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2
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Díaz-Aristizabal U, Valdés-Vilches M, Fernández-Ferreras TR, Calero-Muñoz E, Bienzobas-Allué E, Aguilera-Ballester L, Carnicer-Cáceres J. Effect of botulinum toxin type A in functionality, synkinesis and quality of life in peripheral facial palsy sequelae. Neurologia 2023; 38:560-565. [PMID: 37437657 DOI: 10.1016/j.nrleng.2023.07.003] [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: 11/18/2020] [Accepted: 01/10/2021] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). MATERIAL AND METHODS We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox© or Xeomin©) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. RESULTS Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). CONCLUSIONS BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.
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Affiliation(s)
- U Díaz-Aristizabal
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain.
| | - M Valdés-Vilches
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - T R Fernández-Ferreras
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - E Calero-Muñoz
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - E Bienzobas-Allué
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - L Aguilera-Ballester
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - J Carnicer-Cáceres
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
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Li S, Xie S, Li Z, Ding M, Shan X, Zhang L, Yu G, Cai Z. Facial Reanimation After Peripheral Facial Nerve Paralysis: A Single-institution Surgical Experience. J Craniofac Surg 2023; 34:1841-1844. [PMID: 37427918 DOI: 10.1097/scs.0000000000009513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Facial nerve trauma occasionally develops during oral and maxillofacial surgery. This study was aimed at enhancing the available knowledge on facial nerve reanimation correlated to surgery and proposing our surgical algorithm. We retrospectively analyzed medical records of patients who underwent facial reanimation surgery at our hospital. The inclusion criterion was surgery for facial reanimation from January 2004 to June 2021. We included 383 eligible patients who underwent facial reanimation surgery. Trauma or maxillofacial neoplasms were noted in 208 of 383 and 164 of 383 cases, respectively. In 238 of 383 cases, nerve branches were likely more vulnerable. Facial nerve anastomosis was performed in 256 patients. Sixty-eight patients received nerve grafts. In 22 patients, distal facial nerve transfer to the masseteric nerve, sublingual nerve, or contralateral facial nerve was performed. Twenty-five patients received static surgery; in most cases, the temporalis fascia flap (20/25) was used. The nerve function outcomes were HB grade I (n=17), Grade Ⅱ (n=108), Grade Ⅲ (n=118), Grade Ⅳ (n=94), and Grade V (n=46). The mean follow-up time was 4.88 ± 3.93 years. Facial paralysis caused by trauma ( P =0.000), branch injury ( P =0.000), and the primary reconstruction of facial nerve ( P =0.000) were predictive of favorable treatment outcomes. Although facial nerve injury caused by trauma was more likely, cases of interference in facial expression could be limited, and so did the injury to branches. Nerve anastomosis was prioritized if a tension-free suture was possible. Maintaining the integrity of the nerve and shortening the duration of mimetic muscular denervation were crucial.
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Affiliation(s)
- Shijun Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Haidian District, Beijing, China
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4
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Pan DR, Clark NW, Chiang H, Kahmke RR, Phillips BT, Barrett DM. The evolution of facial reanimation techniques. Am J Otolaryngol 2023; 44:103822. [PMID: 36934594 DOI: 10.1016/j.amjoto.2023.103822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
This review article provides an updated discussion on evidence-based practices related to the evaluation and management of facial paralysis. Ultimately, the goals of facial reanimation include obtaining facial symmetry at rest, providing corneal protection, restoring smile symmetry and facial movement for functional and aesthetic purposes. The treatment of facial nerve injury is highly individualized, especially given the wide heterogeneity regarding the degree of initial neuronal insult and eventual functional outcome. Recent advancements in facial reanimation techniques have better equipped clinicians to approach challenging patient scenarios with reliable, effective strategies. We discuss how technology such as machine learning software has revolutionized pre- and post-intervention assessments and provide an overview of current controversies including timing of intervention, choice of donor nerve, and management of nonflaccid facial palsy with synkinesis. We highlight novel considerations to mainstay conservative management strategies and examine innovations in modern surgical techniques with a focus on gracilis free muscle transfer. Innervation sources, procedural staging, coaptation patterns, and multi-vector and multi-muscle paddle design are modifications that have significantly evolved over the past decade.
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Affiliation(s)
- Debbie R Pan
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Nicholas W Clark
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Harry Chiang
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Russel R Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Brett T Phillips
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University, Durham, NC, United States of America
| | - Dane M Barrett
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America.
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5
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Ahsanuddin S, Roy S, Nasser W, Povolotskiy R, Paskhover B. 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] [MESH Headings] [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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Affiliation(s)
- Salma Ahsanuddin
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Savannah Roy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wissam Nasser
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Roman Povolotskiy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Boris Paskhover
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Facial Plastics and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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6
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Funk EK, Greene JJ. Advances in Facial Reanimation: Management of the Facial Nerve in the Setting of Vestibular Schwannoma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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7
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Díaz-Aristizabal U, Valdés-Vilches M, Fernández-Ferreras TR, Calero-Muñoz E, Bienzobas-Allué E, Aguilera-Ballester L, Carnicer-Cáceres J. Effect of botulinum toxin typeA in functionality, synkinesis and quality of life in peripheral facial palsy sequelae. Neurologia 2021; 38:S0213-4853(21)00032-3. [PMID: 33722453 DOI: 10.1016/j.nrl.2021.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). MATERIAL AND METHODS We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox® or Xeomin®) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. RESULTS Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). CONCLUSIONS BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.
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Affiliation(s)
- U Díaz-Aristizabal
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España.
| | - M Valdés-Vilches
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
| | - T R Fernández-Ferreras
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
| | - E Calero-Muñoz
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
| | - E Bienzobas-Allué
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
| | - L Aguilera-Ballester
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
| | - J Carnicer-Cáceres
- Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, España
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8
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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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9
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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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10
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Fuzi J, Taylor A, Sideris A, Meller C. Does Botulinum Toxin Therapy Improve Quality of Life in Patients with Facial Palsy? Aesthetic Plast Surg 2020; 44:1811-1819. [PMID: 32700008 DOI: 10.1007/s00266-020-01870-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To review the current literature for the efficacy of botulinum toxin therapy to improve quality of life in patients with facial palsy. METHODS A comprehensive systematic literature search was performed of the Medline, EMBase, PubMed and Cochrane Library databases. The population of interest was patients with facial palsy and the intervention of interest was botulinum toxin injection. The primary outcome of this review was quality of life outcomes before and after treatment. RESULTS Six studies were included for review. Outcome data were not amenable to meta-analysis due to the heterogeneity of outcome measures. There was an overall trend towards improvement in quality of life after botulinum toxin therapy with the majority of studies demonstrating a statistically significant benefit. The aspects of life in which patients saw benefit varied amongst studies. No patient factors were identified to predict which sub-cohort would likely have the greatest benefit from therapy. Two studies reported adverse effects to be common however minor in nature. CONCLUSION This review presents contemporary evidence that botulinum toxin is of benefit to the quality of life of patients with facial palsy. Additional larger randomised control trials would aid clinicians in quantifying the benefit of such therapies for patients with facial palsy. LEVEL OF EVIDENCE III 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)
- Jordan Fuzi
- Department of Otolaryngology, Head and Neck Surgery, Prince of Wales Hospital, Barker St, Randwick, NSW, 2031, Australia.
| | - Alon Taylor
- Department of Otolaryngology, Head and Neck Surgery, Prince of Wales Hospital, Barker St, Randwick, NSW, 2031, Australia
| | - Anders Sideris
- Department of Otolaryngology, Head and Neck Surgery, Prince of Wales Hospital, Barker St, Randwick, NSW, 2031, Australia
| | - Catherine Meller
- Department of Otolaryngology, Head and Neck Surgery, Prince of Wales Hospital, Barker St, Randwick, NSW, 2031, Australia
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Moraleda S, Hachoue Z, Abdel-Muti E, Ruiz G, Díez Sebastián J, Lassaletta L. [Satisfaction survey of patients with sequels of peripheral facial palsy treated with botulinum toxin A]. Rehabilitacion (Madr) 2020; 54:254-259. [PMID: 32441261 DOI: 10.1016/j.rh.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Treatment of peripheral facial palsy with botulinum toxin A is safe and effective. Although its beneficial impact on patients' quality of life is known, to date, there have been no studies specifically analysing patients' subjective perceptions. PATIENTS AND METHOD We performed a prospective study in a random sample of patients with sequels of peripheral facial palsy treated with botulinum toxin in the Physical Medicine and Rehabilitation Service of our hospital. We created a simple questionnaire to assess both patient satisfaction and subjective perception of improvement after botulinum toxin treatment. RESULTS After infiltration, 95% of the patients felt good or very good. More than 80% noted improvement in the sensation of tightness in the cheek and neck. Around 75% of patients perceived an improvement in the range of voluntary movement and approximately 80% reported improvement in synkinesis. Almost all the patients would repeat the treatment, if proposed, and 100% would recommend botulinum toxin infiltration to other patients with facial palsy. CONCLUSIONS Patients treated with botulinum toxin experience substantial subjective improvement in the sequels of peripheral facial palsy, both in repose and in the control of synkinesis. Satisfaction was higher than 8/10 in 99% of patients in this study.
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Affiliation(s)
- S Moraleda
- Unidad de Parálisis Facial, Servicio de Medicina Física y Rehabilitación, Hospital Universitario La Paz, Madrid, España.
| | - Z Hachoue
- Unidad de Parálisis Facial, Servicio de Medicina Física y Rehabilitación, Hospital Universitario La Paz, Madrid, España
| | - E Abdel-Muti
- Unidad de Parálisis Facial, Servicio de Medicina Física y Rehabilitación, Hospital Universitario La Paz, Madrid, España
| | - G Ruiz
- Unidad de Parálisis Facial, Servicio de Medicina Física y Rehabilitación, Hospital Universitario La Paz, Madrid, España
| | - J Díez Sebastián
- Servicio de Medicina Preventiva, Hospital Universitario La Paz, Madrid, España
| | - L Lassaletta
- Unidad de Parálisis Facial, Servicio de ORL, Hospital Universitario La Paz, Madrid, España
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12
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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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13
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Heydenrych I. The Treatment of Facial Asymmetry with Botulinum Toxin: Current Concepts, Guidelines, and Future Trends. Indian J Plast Surg 2020; 53:219-229. [PMID: 32884188 PMCID: PMC7458832 DOI: 10.1055/s-0040-1715189] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This article will describe facial asymmetry secondary to facial nerve paralysis (FNP), and review current concepts, guidelines, and future trends. Despite the increasing use of botulinum toxin (BoNTA) in treating FNP, ideal dosage, timing, and additional therapies are not unequivocally established. Facial asymmetry significantly impacts quality of life (QOL) by strongly affecting self-perception and social interactions; injectables may mediate great clinical improvement. This article provides practical guidelines for the use of BoNTA and provides schemes for accurate assessment and documentation. A systematic, stepwise approach is recommended with methodical assessment, meticulous placement, conservative dosage, and careful follow-up. Future trends include the potential use of newly developed toxins, muscle modification with fillers, improved imaging techniques, and targeted QOL studies. Hopefully, a growing number of aesthetic injectors may become technically proficient and join multidisciplinary teams for managing FNP.
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Affiliation(s)
- Izolda Heydenrych
- Department of Dermatology, Cape Town Cosmetic Dermatology Centre, Central Park on Esplanade, Century City, Cape Town, South Africa
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15
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Occhiogrosso J, Derakhshan A, Hadlock TA, Shanley KM, Lee LN. Dermal Filler Treatment Improves Psychosocial Well-Being in Facial Paralysis Patients. Facial Plast Surg Aesthet Med 2020; 22:370-377. [PMID: 32520579 DOI: 10.1089/fpsam.2020.0148] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: In the care of the facial paralysis (FP) patient, outcomes have historically focused on facial function rather than the psychosocial burden of the disease state. Yet, FP patients often describe the impact of their disease on domains of psychosocial health. These patient concerns have motivated clinicians to formally recognize and treat nonfunctional sequelae of the disease. Dermal filler therapy (DFT) is a minimally invasive reversible procedure that can be used to treat facial asymmetry and improve psychosocial well-being in FP patients. However, there are no data describing outcomes of DFT in FP-related facial asymmetry. Therefore, we sought to formally characterize FP patients' facial symmetry and psychosocial well-being before and after DFT. Methods: FP patients presenting for DFT at a tertiary academic medical center were prospectively interviewed. Patients completed the validated FACE-Q for Appearance-Related Psychosocial Distress instrument. Self-reported facial symmetry scores were recorded. Patients were evaluated before and 2 weeks after DFT. Statistical analysis was performed on R software using paired sample t-tests. Results: Twenty FP patients completed DFT treatment and two surveys. The cohort was predominantly female (n = 19, 95%) with an average age of 54 years. After a single treatment of DFT averaging 2.3 mL, patients had significant improvement in facial symmetry and psychosocial well-being. Patients felt particular improvement in self-confidence and emotional expression (p < 0.0001 for all stated comparisons). Conclusion: FP of varying etiologies is associated with significant functional, psychosocial, and quality-of-life impairments. This is the first prospective study to demonstrate statistically significant improvements in facial symmetry and psychosocial well-being after a single office-based treatment of dermal filler. In addition, our study's emphasis on psychosocial health instruments reflects an increased awareness of this important domain in the care of the FP patient.
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Affiliation(s)
- Jessica Occhiogrosso
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Adeeb Derakhshan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kerry M Shanley
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Linda N Lee
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Park EJ, In SK, Yi HS, Kim HI, Kim HS, Kim HY. Treatment of post-traumatic chin deformities using bilateral botulinum toxin injections. Arch Craniofac Surg 2019; 20:310-313. [PMID: 31658795 PMCID: PMC6822072 DOI: 10.7181/acfs.2019.00199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/25/2019] [Indexed: 11/20/2022] Open
Abstract
Post-traumatic hematoma formation is a common complication of contusion. If the hematoma is large enough to aspirate or drain, it can be treated quickly and appropriately. However, if the hematoma is small or concealed by local swelling, it may be overlooked and left untreated. In most cases, a hematoma will resolve following conservative treatment; however, associated infection or muscle fibrosis can occur. Herein, we present the case of a patient with a chin deformity caused by a post-traumatic hematoma. The deformity was treated using botulinum toxin and triamcinolone acetonide injections as minimally invasive treatments. The course of treatment was good.
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Affiliation(s)
- Eon Ju Park
- Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, Korea
| | - Seok Kyung In
- Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, Korea
| | - Hyung Suk Yi
- Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, Korea
| | - Hong Il Kim
- Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, Korea
| | - Ho Sung Kim
- Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, Korea
| | - Hyo Young Kim
- Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, Korea
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Contralateral Botulinum Toxin Improved Functional Recovery after Tibial Nerve Repair in Rats. Plast Reconstr Surg 2019; 142:1511-1519. [PMID: 30188467 DOI: 10.1097/prs.0000000000004981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is clinical and experimental evidence that botulinum toxin applied to the healthy side of patients with facial paralysis positively affects functional recovery of the paralyzed side. The authors created an experimental model to study the effects of botulinum toxin injection in the gastrocnemius muscle contralateral to the side of tibial nerve lesion/repair in rats. METHODS Fifty rats were allocated into five groups: group I, control; group II, tibial nerve section; group III, tibial nerve section and immediate neurorrhaphy; group IV, tibial nerve section, immediate neurorrhaphy, and botulinum toxin injected into the contralateral gastrocnemius muscle; and group V, botulinum toxin injected into the gastrocnemius muscle and no surgery. Assessment tools included a walking track, electromyography, gastrocnemius muscle weight measurement, and histologic analysis of the nerve. RESULTS Paralysis in group V was transient, with function returning to normal at 8 weeks. At 12 weeks, group V had lower latency levels. At week 12, group IV showed higher functional outcomes and amplitude levels than group III, and lower muscle atrophy on the side injected with botulinum toxin compared with group V. CONCLUSION Transient paralysis of the contralateral gastrocnemius muscle by botulinum toxin type A improved functional recovery in rats that underwent section and repair of the tibial nerve.
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Botulinum toxin therapy of hemifacial spasm: bilateral injections can reduce facial asymmetry. J Neurol 2018; 265:2097-2105. [DOI: 10.1007/s00415-018-8960-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/24/2018] [Accepted: 06/23/2018] [Indexed: 10/28/2022]
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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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21
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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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Panossian A. Lengthening Temporalis Myoplasty for Single-Stage Smile Reconstruction in Children with Facial Paralysis. Plast Reconstr Surg 2016; 137:1251-1261. [PMID: 26761513 DOI: 10.1097/prs.0000000000002009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Free muscle transfer for dynamic smile reanimation in facial paralysis is not always predictable with regard to cosmesis. Hospital stays range from 5 to 7 days. Prolonged operative times, longer hospital stays, and excessive cheek bulk are associated with free flap options. Lengthening temporalis myoplasty offers single-stage smile reanimation with theoretical advantages over free tissue transfer. METHODS From 2012 to 2014, 18 lengthening temporalis myoplasties were performed in 14 children for smile reconstruction. A retrospective chart review was completed for demographics, operative times, length of hospital stay, and perioperative complications. RESULTS Fourteen consecutive patients with complete facial paralysis were included. Four patients underwent single-stage bilateral reconstruction, and 10 underwent unilateral procedures. Diagnoses included Möbius syndrome (n = 5), posterior cranial fossa tumors (n = 4), posttraumatic (n = 2), hemifacial microsomia (n = 1), and idiopathic (n = 2). Average patient age was 10.1 years. Average operative time was 410 minutes (499 minutes for bilateral lengthening temporalis myoplasty and 373 for unilateral lengthening temporalis myoplasty). Average length of stay was 3.3 days (4.75 days for bilateral lengthening temporalis myoplasty and 2.8 for unilateral lengthening temporalis myoplasty). Nine patients required minor revisions. CONCLUSIONS Lengthening temporalis myoplasty is a safe alternative to free tissue transfer for dynamic smile reconstruction in children with facial paralysis. Limited donor-site morbidity, shorter operative times, and shorter hospital stays are some benefits over free flap options. However, revisions are required frequently secondary to tendon avulsions and adhesions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Andre Panossian
- Los Angeles, Calif.,From the Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
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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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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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Comparison of the efficacy of onabotulinumtoxinA and abobotulinumtoxinA at the 1: 3 conversion ratio for the treatment of asymmetry after long-term facial paralysis. Plast Reconstr Surg 2015; 135:239-249. [PMID: 25285681 DOI: 10.1097/prs.0000000000000800] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Botulinum toxin A injection into the nonparalyzed side is used to treat asymmetry resulting from facial palsy. OnabotulinumtoxinA and abobotulinumtoxinA units are not equivalent. The authors compared the conversion ratio of 1:3 in patients with facial palsy. METHODS Fifty-five patients (age, 16 to 67 years; 43 women) with longstanding facial palsy were randomly treated with either onabotulinumtoxinA (n = 25) or abobotulinumtoxinA (n = 30) injections into the nonparalyzed side. Adverse effects, facial symmetry, subjective satisfaction, and Facial Disability Index were assessed after 1 and 6 months. RESULTS The incidence of adverse effects was higher with abobotulinumtoxinA (93.3 percent versus 64.0 percent; p = 0.007). Clinical scores of the nonparalyzed side decreased after 1 month and increased again at 6 months, with no between-group differences. Scores of the paralyzed side were lower in the onabotulinumtoxinA group before treatment, but similar in both groups thereafter. The paralyzed side scores increased after 1 month, and at 6 months were still higher than the pretreatment scores in both groups. Subjective assessment improved at all time points compared with pretreatment scores and differed between the two groups only at 1 month, when the abobotulinumtoxinA group was a bit too paralyzed. The physical function and social/well-being function subscales of the Facial Disability Index did not differ between the two groups. CONCLUSIONS Both toxins efficiently reduced asymmetry in patients with facial palsy. Adverse effects were higher with abobotulinumtoxinA at an equivalence ratio of 1:3. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Bianchi B, Ferri A, Ferrari S, Leporati M, Ferri T, Sesenna E. Ancillary Procedures in Facial Animation Surgery. J Oral Maxillofac Surg 2014; 72:2582-90. [DOI: 10.1016/j.joms.2014.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 06/18/2014] [Accepted: 07/21/2014] [Indexed: 11/25/2022]
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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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