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OBJECTIVE: This study aimed to investigate the clinical application and efficacy of local injection of botulinum toxin A (BTX-A) at the depressor anguli oris in patients with congenital drooping mouth corner. METHODS: From September 2013 to March 2015, 36 cosmetic patients received local injections of botulinum toxin A at the depressor anguli oris, with 1-3 injection sites in the moving region of the depressor anguli oris on each side. At each injection site, 2-4 U of BTX-A was injected, and the total dose for any unilateral treatment did not exceed 8 U. The change in the degree of drooping of the mouth corner before and after the injection was analyzed using statistical methods. The clinical efficacy, preservation time, and adverse reactions were observed. RESULTS: The degree of drooping of the mouth corners of the cosmetic patients before the treatment was compared with that at 1 month after using a paired t test, and the difference was statistically significant, with P < 0.01. The treatment results were satisfactory, and the effect was preserved for 6-9 months. None of the 36 cosmetic patients had any complications of bruising, infection, dysfunction in opening and closing the mouth, smile asymmetry, drooling, or dysarthria after the injection. CONCLUSIONS: The local injection of BTX-A at the depressor anguli oris can effectively lift a drooping mouth corner, thereby improving the depressed, stern, and aged appearance of the face. The performance of this treatment is simple, safe, and easy to perform in clinical applications. 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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Toxinas Botulínicas Tipo A/administración & dosificación , Asimetría Facial/congénito , Asimetría Facial/tratamiento farmacológico , Músculos Faciales/efectos de los fármacos , Adulto , Estudios de Cohortes , Estética , Expresión Facial , Músculos Faciales/fisiopatología , Femenino , Humanos , Inyecciones Intramusculares , Labio/efectos de los fármacos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: It is theorized that brow elevation after treatment with botulinum toxin Type A (BoNT-A) results from inactivation of the brow depressors. Expert consensus is that increased injection depth delivers more BoNT-A to these depressors and causes increased elevation. This technique is applied to the correction of brow height asymmetry. OBJECTIVE: To compare changes in brow height after deep versus shallow BoNT-A in patients with brow asymmetry. METHODS: A prospective split-face analysis was performed on 23 women with eyebrow-height asymmetry. Subjects received 64 units of BoNT-A, divided among 16 injection sites in the glabella, forehead, and lateral canthal area. On the side where increased brow lift was desired, deep injections were performed and shallow injections on the opposite side. Photographs were taken at baseline and Week 4 for comparison measurements. RESULTS: All 23 women enrolled completed baseline injections and returned for the 4-week follow-up. There was no significant difference at 4 weeks in the change in brow height between the sides that received deep versus shallow BoNT-A injection. CONCLUSION: Because of the diffusion of the BoNT-A between muscle layers, the eyebrow depressor muscles cannot be accurately targeted with deep injection into the muscle belly for correction of eyebrow height discrepancies.
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Toxinas Botulínicas Tipo A/administración & dosificación , Cejas , Asimetría Facial/tratamiento farmacológico , Fármacos Neuromusculares/administración & dosificación , Adulto , Toxinas Botulínicas Tipo A/efectos adversos , Femenino , Humanos , Inyecciones Intramusculares/métodos , Persona de Mediana Edad , Fármacos Neuromusculares/efectos adversos , Estudios ProspectivosRESUMEN
BACKGROUND: Botulinum toxin type A (BoNT-A) is widely used to improve the lower facial contour. OBJECTIVE: To determine the difference in the changes in the lower facial contour achieved with 1 and 2 sessions of BoNT-A injections using 3-dimensional (3D) laser scanning. MATERIALS AND METHODS: Twenty volunteers were randomly divided into 2 groups. Group I (n = 10) received a single injection, whereas Group II (n = 10) received 2 sessions of injections, the second being administered 4 months after the first. Each injection comprised of 25 U of BoNT-A and was administered to the masseter muscle bilaterally. Evaluation of the effect of BoNT-A injection was performed using 3D laser scan images obtained before the injection and 6 months thereafter in Group I, and before the first injection and 6 months thereafter in the Group II. RESULTS: The mean changes in the volume and thickness in Group I were -1,186 mm and -1.52 mm, respectively; the corresponding changes were -4,072 mm and -3.84 mm in Group II. The reductions were significantly greater in Group II than in Group I. CONCLUSION: The administration of a second BoNT-A injection is effective for better aesthetic results for the lower facial contour.
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Toxinas Botulínicas Tipo A/administración & dosificación , Asimetría Facial/diagnóstico , Asimetría Facial/tratamiento farmacológico , Imagenología Tridimensional/métodos , Rayos Láser , Adulto , Femenino , Estudios de Seguimiento , Voluntarios Sanos , Humanos , Inyecciones Intramusculares , Masculino , Músculo Masetero , Persona de Mediana Edad , Fármacos Neuromusculares/administración & dosificación , Estudios Retrospectivos , Adulto JovenRESUMEN
Piribedil is a non-ergoline, dopamine D(2)/D(3) receptor agonist with α(2) adrenoceptor antagonist properties that has been used in the treatment of Parkinson's disease (PD). Noradrenergic neurotransmission may be involved in the pathogenesis of dyskinesias induced by chronic treatment with L-DOPA (3,4-dihydroxyphenylalanine, levodopa), but its role in the in vivo action of piribedil or on different subclasses of abnormal involuntary movements (AIMs) remains unclear. The aims of this study were therefore (1) to investigate the anti-dyskinetic effects of piribedil on L-DOPA-induced contralateral turning behaviour, locomotive dyskinesias (LD), axial dystonia (AD), orolingual dyskinesia (OD) and forelimb dyskinesia (FD) and (2) to compare these effects to the α(2) adrenoceptor antagonist, idazoxan, or the α(2) adrenoceptor agonist, clonidine. Rats were unilaterally lesioned with 6-hydroxydopamine (6-OHDA) and injected intraperitoneally twice daily with L-DOPA methylester (12.5 mg/kg) and benserazide (3.25 mg/kg). After 3 weeks, the effects of piribedil (5, 15, 40 mg/kg), clonidine (0.15 mg/kg), idazoxan (10 mg/kg) and combinations of these drugs were scored during 2 h. Pre-treatment with 5 and 40 mg/kg, but not 15 mg/kg, of piribedil reduced turning behaviour and AD, OD and FD, but piribedil increased LD at the 40 mg/kg doses compared to the L-DOPA group. Idazoxan induced similar effects as piribedil (40 mg/kg), except that it had no effect on LD. Idazoxan blocked the effect of piribedil on AD and FD. Clonidine reduced all AIMs except OD, possibly because of its sedative effect. Clonidine blocked the effect of piribedil on AD, OD and FD. These data suggest a differential involvement of α(2) adrenergic receptors in the action of piribedil on different subclasses of L-DOPA-induced dyskinesias.
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Antiparkinsonianos/efectos adversos , Discinesia Inducida por Medicamentos/etiología , Discinesia Inducida por Medicamentos/prevención & control , Levodopa/efectos adversos , Piribedil/uso terapéutico , Receptores Adrenérgicos alfa 2/metabolismo , Adrenérgicos/toxicidad , Agonistas de Receptores Adrenérgicos alfa 2/administración & dosificación , Antagonistas de Receptores Adrenérgicos alfa 2/administración & dosificación , Animales , Benserazida/administración & dosificación , Clonidina/uso terapéutico , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Distonía/inducido químicamente , Distonía/tratamiento farmacológico , Asimetría Facial/inducido químicamente , Asimetría Facial/tratamiento farmacológico , Idazoxan/administración & dosificación , Locomoción/efectos de los fármacos , Oxidopamina/toxicidad , Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/etiología , Ratas , Ratas Sprague-Dawley , Estadísticas no Paramétricas , Extremidad Superior/fisiopatologíaRESUMEN
BACKGROUND: Many patients with a hypertrophic masseter muscle desire its reduction to decrease the prominent mandibular angle. Surgical reduction has been widely used to this end, but bilateral injection of botulinum toxin into the masseter muscle is a less-invasive alternative to surgical reduction that has recently become the focus of public interest. The aim of this study was to measure changes in volume and thickness unilaterally in hypertrophic masseter muscles after unilateral botulinum toxin type A (BoNT-A) injection using three-dimensional (3D) laser scanning as a method of evaluation. METHODS AND MATERIALS: The volume and thickness of the lower facial contour of 10 patients with unilateral hypertrophic masseter muscle were measured using 3D laser scanning before and 4, 8, and 12 weeks after a unilateral injection of 25 U of BoNT-A. The 3D scans were superimposed to determine postinjection changes in volume and thickness. RESULTS: Although there was little change in the noninjected side over the experimental period, the mean volume and thickness of the injected side at each time point clearly and statistically significantly decreased between preinjection and 4, 8, and 12 weeks postinjection. CONCLUSION: Unilateral BoNT-A injection appears to be an effective esthetic treatment for patients with muscle-induced facial asymmetry.
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Toxinas Botulínicas Tipo A/administración & dosificación , Asimetría Facial/diagnóstico , Asimetría Facial/tratamiento farmacológico , Imagenología Tridimensional , Rayos Láser , Adulto , Femenino , Humanos , Masculino , Adulto JovenAsunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Asimetría Facial/congénito , Asimetría Facial/fisiopatología , Músculos Faciales/anomalías , Músculos Faciales/fisiopatología , Parálisis Facial/congénito , Parálisis Facial/fisiopatología , Labio/fisiopatología , Fármacos Neuromusculares/uso terapéutico , Adolescente , Diagnóstico Diferencial , Asimetría Facial/tratamiento farmacológico , Femenino , HumanosRESUMEN
The treatment of hemifacial spasm with periorbital injections of higher doses of botulinum toxin can create disfiguring and undesirable weakness in the lower face during active facial movements. The use of asymmetric hyaluronidate filler injections to the lower face provides a refinement allowing for a lowered neurotoxin dose. The filler creates a ballasting effect and involuntary facial movement. The conventional filler effect also further reduces asymmetric nasolabial folds and marionette lines. Fifteen of 18 patients with lower facial spasms found the filler toxin combination an improvement over neurotoxin alone.
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Toxinas Botulínicas Tipo A/uso terapéutico , Asimetría Facial/tratamiento farmacológico , Espasmo Hemifacial/tratamiento farmacológico , Ácido Hialurónico/uso terapéutico , Fármacos Neuromusculares/uso terapéutico , Quimioterapia Combinada , Humanos , Inyecciones IntradérmicasRESUMEN
PURPOSE: To assess the long-term results of the treatment of oculofacial asymmetries using a combined injection schedule for injections of hyaluronic acid, with a specific micro cannula and botulinum toxin. METHOD: A retrospective study was conducted from January 2009 to January 2010. Patients were treated in the Alcazar Eye Clinic and Oculoplastic Department in Princess Grace Hospital, Monaco. We selected patients complaining of asymmetrical periorbital features who received treatment with hyalurostructure and botulinum toxin injection in one or more sessions. Nine patients were selected and presented with the following symptoms: asymmetry of eyebrow position (2 patients), superior orbital hollow (2 patients), tear trough (2 patients) and orbital volume (ocular prosthesis) (3 patients). The objective was to evaluate the efficiency of combined treatment in one or more sessions on these oculofacial asymmetries. Hyaluronic acid injections were done using hyalurostructure. Hyaluronic acid gel (Restylane Lidocaine) was used with a 25 gauge reinforced micro-cannula (pix'l +, Thiebaud). This was combined with injections of botulinum toxin (azzalure*) to areas of muscular hyperaction. Follow-up was done at 1 year by clinical examination, photography and patient satisfaction. Complications of this combined treatment have been identified. RESULTS: At 1-year follow-up, 88% of patients were satisfied or very satisfied with their results. There were no more complications secondary to both treatments in the same session. It was not noticed more hematomas and bruises than in classical injection method. The action of toxin is constant over time despite the association of hyaluronic acid injections. CONCLUSION: Combined treatments with toxin and hyaluronic acid in oculofacial asymmetries are efficient and can be proposed in the same session. These treatments must be repeated to maintain and optimize muscle contraction and volume loss. Use of hyalurostructure and botulinum toxin treatment in the same session is effective and safe.
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Toxinas Botulínicas Tipo A/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Asimetría Facial/tratamiento farmacológico , Ácido Hialurónico/análogos & derivados , Fármacos Neuromusculares/uso terapéutico , Adulto , Técnicas Cosméticas , Quimioterapia Combinada , Ojo , Femenino , Humanos , Ácido Hialurónico/uso terapéutico , Masculino , Satisfacción del Paciente , Estudios RetrospectivosAsunto(s)
Resinas Acrílicas/efectos adversos , Toxinas Botulínicas Tipo A/uso terapéutico , Rellenos Dérmicos/efectos adversos , Asimetría Facial/inducido químicamente , Asimetría Facial/tratamiento farmacológico , Migración de Cuerpo Extraño/tratamiento farmacológico , Fármacos Neuromusculares/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , ÓrbitaRESUMEN
BACKGROUND: Depressor anguli oris muscle hypertonicity in synkinetic facial paralysis patients may have an overpowering antagonistic effect on facial symmetry. Depressor anguli oris muscle block is a crucial diagnostic test before any treatment planning. Presented is the largest patient cohort analysis to date on static and dynamic facial symmetry changes after depressor anguli oris muscle block. METHODS: Unilateral synkinetic patients with depressor anguli oris muscle hypertonicity were included. Resting symmetry and smile modiolus angle, excursion, and exposure of teeth were measured on both synkinetic and healthy hemifaces before and after depressor anguli oris muscle block using Emotrics and FaceGram photographic analyses. RESULTS: Thirty-six patients were included. Before depressor anguli oris block, resting modiolus height was elevated on the synkinetic side (p = 0.047). During open-mouth smile, reduced modiolus angle (p < 0.0001), modiolus excursion (p < 0.0001), and exposure of teeth (p < 0.0001) were observed on the synkinetic hemiface. After depressor anguli oris block, resting modiolus height became symmetric (p = 0.64). During open-mouth smile, modiolus angle and exposure of teeth significantly increased (both p < 0.0001); excursion did not improve on the synkinetic side (p = 0.13) but unexpectedly improved in open-mouth smile on the healthy side (p = 0.0068). CONCLUSIONS: Depressor anguli oris muscle block improved resting symmetry and modiolus angle and exposure of teeth during smile, demonstrating the inhibitory mimetic role of a hypertonic depressor anguli oris muscle in synkinesis. It is a critical diagnostic and communication tool in the assessment and treatment planning of depressor anguli oris muscle hypertonicity, suggesting the potential effects of future depressor anguli oris myectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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Asimetría Facial/tratamiento farmacológico , Músculos Faciales/fisiopatología , Parálisis Facial/fisiopatología , Hipertonía Muscular/tratamiento farmacológico , Bloqueo Neuromuscular/métodos , Sincinesia/etiología , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Asimetría Facial/etiología , Expresión Facial , Músculos Faciales/efectos de los fármacos , Parálisis Facial/diagnóstico , Parálisis Facial/cirugía , Femenino , Humanos , Inyecciones Intramusculares , Lidocaína/farmacología , Lidocaína/uso terapéutico , Masculino , Persona de Mediana Edad , Hipertonía Muscular/etiología , Bloqueantes Neuromusculares/farmacología , Bloqueantes Neuromusculares/uso terapéutico , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Sonrisa , Resultado del Tratamiento , Adulto JovenRESUMEN
The purpose of this study was to compare the efficacy of botulinum toxin (BoNT) in masseter muscle reduction depending on the amount of chin deviation. Exploring distinctive effects of BoNT relative to the characteristics of facial asymmetry will aid in planning and predicting treatment outcomes. Sixteen adult volunteers were classified into two groups according to the degree of menton deviation observed in posteroanterior cephalograms. Eight had a menton deviation of 3 mm or more and the other eight had less than 3 mm. A total of 25 Units of BoNT was injected into the unilateral masseter muscle of the prominent side for each participant. Changes in the volume and bulkiest height of the lower face on each side were measured with a 3D laser scan at four time points: before and 4, 8, and 12 weeks after the injection. Two-way mixed ANOVA was employed for analyses. The volume and bulkiest height of the injected side decreased over time in both types of asymmetry, with significant differences at each time point. The reductions in the volume and bulkiest height were significantly greater in subjects without chin deviation. The reductions in the volume and bulkiest height of the lower face using BoNT are more effective for subjects without chin deviation.
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Toxinas Botulínicas Tipo A/administración & dosificación , Mentón , Asimetría Facial/tratamiento farmacológico , Fármacos Neuromusculares/administración & dosificación , Adulto , Toxinas Botulínicas Tipo A/efectos adversos , Cefalometría , Mentón/diagnóstico por imagen , Asimetría Facial/diagnóstico por imagen , Femenino , Humanos , Inyecciones Intramusculares , Masculino , Músculo Masetero , Fármacos Neuromusculares/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: Fibrous dysplasia (FD) is a benign fibro-osseous developmental disorder of growing bone, sometimes involving the craniofacial skeleton (CFD). We wish to present a patient series with CFD of the orbital region and discuss treatment modalities. METHODS: Twelve patients were referred for orbital CFD in the Nantes University Hospital between 2000 and 2018 and studied according to the clinical parameters, radiological features, and modalities of treatment. RESULTS: The mean age was 25.6 years. Ten patients exhibited facial asymmetry with vertical globe dystopia (75%), proptosis (58%) and facial bump (50%). The disease was monostotic in 83% of patients, involving the frontal bone (25%), the sphenoidal bone (33%), the fronto-sphenoidal complex (25%), and the skull base (17%). Unilateral radiological proptosis was found in 7 patients, with a mean protrusion 3.9mm. The optic canal was involved in 75% of patients, with no functional impairment. Three patients were treated with bisphosphonate therapy to stop progression of the disease; 6 patients were given a bone remodelling procedure with good aesthetic outcomes. CONCLUSION: The orbit is a rare localization for FD causing aesthetic and functional disabilities. Medical and surgical treatment can be proposed as part of a multidisciplinary approach.
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Enfermedades del Desarrollo Óseo , Órbita/patología , Enfermedades Orbitales , Adolescente , Adulto , Anciano , Enfermedades del Desarrollo Óseo/diagnóstico , Enfermedades del Desarrollo Óseo/tratamiento farmacológico , Enfermedades del Desarrollo Óseo/patología , Niño , Estudios de Cohortes , Exoftalmia/tratamiento farmacológico , Exoftalmia/etiología , Exoftalmia/cirugía , Cara/cirugía , Asimetría Facial/tratamiento farmacológico , Asimetría Facial/etiología , Asimetría Facial/cirugía , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Órbita/efectos de los fármacos , Órbita/cirugía , Enfermedades Orbitales/complicaciones , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/cirugía , Estudios Retrospectivos , Adulto JovenRESUMEN
RATIONALE: Facial nerve palsy (FNP) is one of the rare neurologic symptoms of Kawasaki disease (KD), associated with a higher incidence of coronary arteries lesions and may be an indicator of more severe disease. PATIENT CONCERNS: A 3-month-old male infant with persistent fever, irritability, and facial asymmetry. DIAGNOSES: KD with FNP. INTERVENTIONS: The infant received intravenous immunoglobulin (IVIG) (2âg/kg/16âhours) and aspirin (50âmg/kg/day) were started on the 8th day of illness. OUTCOMES: Fever and FNP resolved within 48âhours after IVIG treatment. The inflammatory markers all improved to normal or near-normal levels before discharge; all infectious studies returned negative. His left facial weakness was unappreciable at day of discharge. LESSONS: FNP associated with KD is an uncommon finding but may indicate an increased risk of coronary artery involvement. KD should always be kept in mind in the differential diagnosis of a child who presents with prolonged unexplained fever, even with incomplete diagnostic features, as well as the need to be aware of unusual manifestations, such as FNP.
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Anomalías de los Vasos Coronarios/etiología , Asimetría Facial/etiología , Parálisis Facial/etiología , Síndrome Mucocutáneo Linfonodular/diagnóstico , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Ecocardiografía , Asimetría Facial/tratamiento farmacológico , Parálisis Facial/tratamiento farmacológico , Humanos , Inmunoglobulinas Intravenosas/administración & dosificación , Factores Inmunológicos/administración & dosificación , Lactante , Masculino , Síndrome Mucocutáneo Linfonodular/complicacionesRESUMEN
Botulinum toxin (BT) is the treatment of choice for hemifacial spasm (HFS). When BT is injected into the affected side, patients may experience increased facial asymmetry. We wanted to evaluate in a prospective, randomised, placebo-controlled study whether bilateral BT injections may reduce this facial asymmetry. For this, we treated 19 HFS patients with unilateral and 24 with bilateral BT therapy using CBTX-A (Lanzhou Biological Products Institute, Lanzhou, China). BT doses on the affected side were standard doses, on the non-affected side they were one-third of those. Facial asymmetry was studied with the Sunnybrook facial grading system (SFGS), the Facial Clinimetric Evaluation Scale (FaCE), the Symmetry Scale for Hemifacial Spasm (SSHS) and a self-assessment scale. As shown in SFGS and SSHS, bilateral BT therapy reduces facial asymmetry, whilst unilateral BT therapy increases it. Both effects are more pronounced during voluntary facial movements than at rest. BT effect delay, BT effect duration, adverse effect frequency and severity were not affected. FaCE total score, some of its subscores and the self-assessment scale did not show an effect. Bilateral BT therapy may improve the outcome of BT therapy for HFS without producing additional adverse effects. This strategy, however, raises drug costs (by about a third). Using even higher doses in the non-affected side may intensify the improvement even further. Future studies may also monitor the patient's quality of life and the naïve public's overall perception of the patient's facial expression.
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Toxinas Botulínicas Tipo A/administración & dosificación , Asimetría Facial/tratamiento farmacológico , Espasmo Hemifacial/tratamiento farmacológico , Fármacos Neuromusculares/administración & dosificación , Evaluación de Resultado en la Atención de Salud/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: To describe our technique for the injection of calcium hydroxylapatite gel (Radiesse) to treat postrhinoplasty contour defects and to evaluate the agent's efficacy, duration of action, required dosage, complication rates, and patient satisfaction. Slight defects or asymmetries are not uncommon, even after well-executed rhinoplasty surgery in the most expert of hands. These contour deformities have been treated with filler agents in the past, but with mixed results. Calcium hydroxylapatite gel was recently introduced as a filler agent in facial plastic surgery, but its use has not yet been described in the correction of postrhinoplasty nasal contour defects. DESIGN: A prospective before-and-after trial conducted in a private-practice facial cosmetic surgery office. Eligible patients had postrhinoplasty contour irregularities or asymmetry. Postrhinoplasty irregularities at the nasal dorsum or tip underwent subcutaneous injection with calcium hydroxylapatite. Main outcome measures included number of treatments, posttreatment injection pain score, required dose and complications, natural feel, patient satisfaction, and length of follow-up. Digital photographs were evaluated by blinded observers. RESULTS: Thirteen patients were followed up prospectively for a mean of 2.5 months. The mean injection pain score was 1.9 (scale, 0-5); the mean dose, 0.19 mL. Patient satisfaction was good to excellent in 11 (85%) of 13 cases. Photographic improvement was seen in 15 (88%) of 17 treatment sites. CONCLUSIONS: Calcium hydroxylapatite gel has been shown in this study to improve postrhinoplasty nasal symmetry and smooth the curves and lines that constitute the contour of the nose. The longevity of nasal augmentation by calcium hydroxylapatite remains unsettled; long-term safety is also unknown. Long-term studies of safety and efficacy are indicated.
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Materiales Biocompatibles/uso terapéutico , Durapatita/uso terapéutico , Asimetría Facial/tratamiento farmacológico , Asimetría Facial/etiología , Complicaciones Posoperatorias/tratamiento farmacológico , Rinoplastia , Materiales Biocompatibles/administración & dosificación , Durapatita/administración & dosificación , Estudios de Seguimiento , Geles , Humanos , Inyecciones , Estudios ProspectivosRESUMEN
BACKGROUND: Facial palsy may be complicated by ipsilateral synkinesis or contralateral hyperkinesis. Botulinum toxin is increasingly used in the management of facial palsy; however, the optimum dose, treatment interval, adjunct therapy and performance as compared with alternative treatments have not been well established. This study aimed to systematically review the evidence for the use of botulinum toxin in facial palsy. METHOD: The Cochrane central register of controlled trials (CENTRAL), MEDLINE(R) (1946 to September 2015) and Embase Classic + Embase (1947 to September 2015) were searched for randomised studies using botulinum toxin in facial palsy. RESULTS: Forty-seven studies were identified, and three included. Their physical and patient-reported outcomes are described, and observations and cautions are discussed. DISCUSSION: Facial asymmetry has a strong correlation to subjective domains such as impairment in social interaction and perception of self-image and appearance. Botulinum toxin injections represent a minimally invasive technique that is helpful in restoring facial symmetry at rest and during movement in chronic, and potentially acute, facial palsy. Botulinum toxin in combination with physical therapy may be particularly helpful. Currently, there is a paucity of data; areas for further research are suggested. A strong body of evidence may allow botulinum toxin treatment to be nationally standardised and recommended in the management of facial palsy.
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Toxinas Botulínicas/uso terapéutico , Parálisis Facial/tratamiento farmacológico , Fármacos Neuromusculares/uso terapéutico , Toxinas Botulínicas/administración & dosificación , Toxinas Botulínicas/efectos adversos , Asimetría Facial/tratamiento farmacológico , Humanos , Inyecciones Intramusculares , Fármacos Neuromusculares/administración & dosificación , Fármacos Neuromusculares/efectos adversosAsunto(s)
Toxinas Botulínicas Tipo A/administración & dosificación , Desnervación , Asimetría Facial/tratamiento farmacológico , Nervio Facial/cirugía , Parálisis Facial/complicaciones , Fármacos Neuromusculares/administración & dosificación , Sincinesia/tratamiento farmacológico , Toxinas Botulínicas Tipo A/uso terapéutico , Esquema de Medicación , Asimetría Facial/etiología , Asimetría Facial/fisiopatología , Músculos Faciales/fisiopatología , Parálisis Facial/fisiopatología , Parálisis Facial/cirugía , Humanos , Inyecciones Intramusculares , Fármacos Neuromusculares/uso terapéutico , Atención Perioperativa , Periodo Posoperatorio , Estudios Retrospectivos , Sonrisa , Sincinesia/etiología , Sincinesia/fisiopatología , Resultado del TratamientoRESUMEN
PURPOSE: To report two patients who experienced improved drinking ability as well as facial appearance with contralateral injection of botulinum toxin. DESIGN: Retrospective case reports. METHODS: Two patients were treated with botulinum toxin contralateral to the VIIth nerve palsy to improve drinking ability as well as facial asymmetry. RESULTS: Botulinum toxin injections improved facial asymmetry as well as drinking ability in two patients with facial nerve palsies. CONCLUSIONS: Contralateral botulinum toxin injections improved drinking ability in two patients with facial nerve palsy.