Abstract
Botulinum toxin (BoNT) injections into facial and bulbar muscles are widely and increasingly used as medical treatments for cervical and facial dystonia, facial hemispasm, correction of facial palsy, hyperhidrosis, as well as cosmetic treatment of glabellar lines associated with grief and anger. Although BoNT treatment is generally considered safe, the diffusion of the toxin to surrounding muscles may result in complications, including difficulties swallowing, in a dose-dependent manner. The sensitivity of clinical examination for detecting adverse events after BoNT treatment is limited. Few reports have highlighted the potential effects on other muscles in the facial area due to the spreading of the toxin. The possibilities of spreading and thus unknown pharmacological BoNT effects in non-targeted muscles emphasise the importance of correct administration of BoNT in terms of dose selection, injection points, and appropriate effect surveillance. In this review article, we will focus on novel objective measures of efficacy and safety regarding BoNT treatment of facial muscles and the reasons why this is important.
Highlights
Botulinum toxin (BoNT) is a highly potent neurotoxin produced by several species included in the
The subsequent effect of BoNT is mediated by the inhibition of acetylcholine release from the motor nerve terminal into the neuromuscular junction [8]
This study suggested BoNT as a safe and effective treatment for chronic masticatory myofascial pain (MMP)
Summary
Botulinum toxin (BoNT) is a highly potent neurotoxin produced by several species included in the. In addition to the seven previously identified serotypes (A-G) of BoNT, another serotype was recently identified as BoNT/X [2], and the first botulinum-like toxin outside the Clostridia family has been described [3]. The use of BoNTs is restricted to the type A and B serotypes, of which the type A serotype is most widely used in small quantities as a treatment in aesthetic and medical indications, most of which are characterised by increased muscle activity (reviewed in [4]). It was described that the heat shock protein Hsp is involved in the entry of clostridial neurotoxins into the cytosol of nerve terminals [5,6,7]. Indications and Special Considerations of Safety Regarding BoNT Applications in Facial and Bulbar Muscles
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