Effectiveness of Botulinum Toxin Injection on Bruxism: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: The present study compiled evidence on the efficacy of botulinum toxin A (BTX) for management of bruxism. METHODS: A literature review that included randomized control, cohort, as well as observational studies published between January 2000 and November 2022 was conducted. All studies related to BTX injections administered into the masseters of patients with bruxism were included. Primary outcomes were measured by performing a meta-analysis of changes in maximal biting forces and pain severity and meta-regression of the effects of the BTX dose. RESULTS: Ten studies were included for quantitative analysis. The analysis of the maximal biting force after BTX injections demonstrated a significant reduction at 1 month or less compared with both oral splints (P < 0.000001) and saline injections (P = 0.01). BTX continued to outperform oral splinting (P = 0.001) and saline placebos (P = 0.03) at 3 months. Between 3 and 6 months, a significantly higher maximal biting strength was observed in the BTX group than the oral splinting group (P < 0.00001). No significant differences in the maximal biting force were observed between the BTX and saline placebo groups (P = 0.50). A similar trend was observed in the analysis of pain reduction after botulinum treatment. Additionally, for every unit increase in the BTX dose, pain severity decreased by 0.0831 points (P = 0.0011). CONCLUSION: BTX is effective in reducing biting strength and pain severity. BTX effects are evident at less than 4 weeks, peak between 5 and 8 weeks, and last for up to 24 weeks. Higher BTX doses result in greater improvement in pain. Although BTX benefits manifest earlier, they gradually diminish, and oral splinting exerts a more enduring effect, especially after 9-12 weeks. BTX injections into masseters are recommended as management options for bruxers, especially for those having difficulties complying with wearing oral splints or those seeking earlier symptom relief. However, future studies should determine BTX effects beyond 24 weeks and after repetitive injections and how bruxers of different ages or genders respond to treatment. 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 .

Reconstruction of a Full-thickness Lateral Alar Defect Using a Superiorly Based Folded Nasolabial Flap Without a Cartilage Graft: A Single-stage Operation.

ABSTRACT: When reconstructing a lateral alar defect of the nose, satisfactory aesthetic and functional results are difficult to achieve through a single-stage surgery alone. Here the authors describe a new innovative surgical technique using a superiorly based folded nasolabial flap through a single-stage surgery alone. An 85-year-old male patient visited plastic surgery clinic with sudden enlargement of a mass 3 or 4 days before the visit. On the basis of the biopsy test results, a diagnosis of basal cell carcinoma on the right lateral alar was made. A full-thickness lateral alar resection was performed while maintaining the shape of the right alar rim (outer skin defect: 2.2 × 2 cm2 and inner mucosal defect: 1.4 × 1.3 cm2). Next, a single-stage reconstruction with a superiorly based folded turnover nasolabial flap was performed for the full-thickness lateral alar defect. Six months after the reconstructive surgery, no wound complication and nostril collapse occurred. The surgical method used in this case has many advantages. First, the authors' method is performed only in a single stage. Second, the flap is based on a rich vascular supply from the angular artery, which eliminates the possibility of flap necrosis through multiple turnovers. Third, because the turnover nasolabial flap is a construct of the epidermis, dermis, and subcutaneous fat, the flap is quite stiff thus reducing the possibility of nostril collapse. Fourth, the procedure leaves no scars in the superior area of the nose other than the nasolabial fold scar.

Preventive Effect of Synthetic Tryptophan Metabolite on Silicone Breast Implant-Induced Capsule Formation.

BACKGROUND: In the field of plastic surgery, capsular contracture after silicone breast implant surgery is a major clinical problem. This experimental study confirms that the synthetic tryptophan metabolite N-(3',4'-dimethoxycinnamonyl) anthranilic acid (Tranilast) reduces capsule formation and prevents capsular contracture. METHODS: Eighteen New Zealand white rabbits were divided into 2 groups. In the experimental group, implants were inserted into each rabbit, and oral synthetic tryptophan metabolite was administered daily at a dose of 5 mg/kg in 10 mL of saline. In the control group, rabbits received implants and the same amount of saline without the metabolite. After 2 months, peri-implant tissues were harvested and analyzed. RESULTS: The thickness of the capsules and the inflammatory cell counts were decreased in the experimental group (P < 0.001). The collagen fibers in the experimental group were thinner, less dense, and more organized than in control group. The results of reverse transcription quantitative polymerase chain reaction analysis showed that the genes for transforming growth factor ß1 (P = 0.002), alpha smooth muscle actin (P < 0.001), and collagen types I (P = 0.002) and III (P = 0.004) were underexpressed in the experimental groups. Furthermore, the counts of T-cell immunity-related cytokine presenting cells were decreased in the experimental groups (CD3, 4, 25, 45RA, 45RO, 69, interleukin-2, 4 [P < 0.001], and interferon γ [P = 0.028]). CONCLUSIONS: This study confirms that a synthetic derivative of a tryptophan metabolite decreases capsule formation and prevents capsular contracture by inhibiting the differentiation of fibroblasts to myofibroblasts, selectively inhibiting collagen synthesis, and decreasing specific T-cell immune responses by changing anti-inflammatory cytokine expression.

Immediate reconstruction of the maxillary sinus after resection of preoperatively misdiagnosed unicystic ameloblastoma with an ectopic third molar.

We report a case of unicystic ameloblastoma associated with an ectopic third molar in the right maxillary sinus, which was misdiagnosed as a dentigerous cyst on preoperative small incisional biopsy. Surgical enucleation of the cystic lesion was performed under general anesthesia with immediate reconstruction of the maxillary sinus using titanium mesh plate. The patient's postoperative recovery was uneventful, and there was no evidence of tumor recurrence during the 7-month follow-up period.

A comparison of triamcinolone acetonide and fibrin glue for seroma prevention in a rat mastectomy model.

BACKGROUND: Seroma formation is one of the most common complications after flap surgery during the postoperative period. Various methods have been developed to overcome this problem, but none of them have been used successfully. Authors used topical triamcinolone acetonide to reduce seroma formation in a rat mastectomy model and compared its effectiveness with fibrin glue. METHODS: In the rat mastectomy model, the authors administered triamcinolone acetonide (experimental group I, n=12), fibrin glue (experimental group II, n=12), and saline (control group, n=12) beneath the skin flap just before closure of the skin. Seroma collections were aspirated and quantified after 7 days, and histologic analysis of the skin flaps and chest walls of the rats was performed. RESULTS: The experimental group I had a reduced mean seroma volume of 1.79±1.32 mL, whereas the experimental group II and control group had mean seroma volumes of 4.04±1.43 mL and 8.51±2.60 mL, respectively (P<0.05). In semiquantitative analysis of inflammation, inflammatory cell count in experimental group I was significantly fewer than in the other 2 groups (P<0.001). In addition, seroma capsule formation did not occur. CONCLUSIONS: Seroma prevention using triamcinolone acetonide is simpler, more economical, and more effective than fibrin glue. In proper concentrations, triamcinolone acetonide can be used to prevent seroma formation in clinical practice.

The viability of diced cartilage grafts wrapped in autogenous fascia and AlloDerm ® in a rabbit model.

Diced cartilage grafting has re-emerged as a popular method in aesthetic rhinoplasty since the introduction of Erol's Turkish delight technique. However, an extensive literature review indicates that diced cartilage grafts with Surgicel(®) wrapping are usually absorbed and often fail to correct associated clinical problems. Recent studies show that significant foreign-body reactions occur in diced cartilage grafts wrapped in Surgicel(®), but not in grafts wrapped in fascia. However, to date, no study has addressed the histological behaviour of diced cartilage wrapped using AlloDerm(®). The primary aim of this study was to compare the viability of diced cartilage wrapped in autogenous fascia to diced cartilage wrapped in AlloDerm(®) in a rabbit model. Ear cartilage and lumbosacral fascia were obtained from six New Zealand white rabbits. Diced cartilage grafts were transplanted to three surgically created subcutaneous pockets on the backs of the rabbits. The rabbits were divided into control group and two experimental groups: control group (group I): diced cartilage (n = 6); experimental group I (group II): diced cartilage wrapped in fascia (n = 6); and experimental group II (group III): diced cartilage wrapped in AlloDerm(®) (n = 6). The grafts were observed 6 months after implantation. Histological processing of the specimens included haematoxylin-eosin (H&E), Masson trichrome, safranin-O, Van Gieson and immunohistochemical staining for glial fibrillary acidic protein. Statistical analysis was performed using the Mann-Whitney test. Results were evaluated at a p < 0.05 significance level. Our histological analysis demonstrated that the chondrocyte regeneration potential, matrix collagen content, and metaplastic bone formation of the AlloDerm(®)-treated group were significantly superior to those of the fascia-treated group. With respect to other histological parameters, the AlloDerm(®)-treated group showed better results than the fascia-treated group, but these results were not statistically significant. The results of our experimental study suggest that AlloDerm(®) may be an excellent material for diced cartilage grafting. Further studies are needed to evaluate the clinical applications of AlloDerm(®) in diced cartilage grafting.