Application Of Botulinum Toxin Research Articles

Frontiers in the Clinical Applications of Botulinum Toxin A as Treatment for Neurogenic Lower Urinary Tract Dysfunction.

Patients with neurogenic lower urinary tract dysfunction (NLUTD) experience urinary incontinence with or without difficult urination, which might promote recurrent urinary tract infection (UTI) and exacerbate upper urinary tract function. Nonetheless, appropriate bladder management has been shown to reduce urological complications and improve quality of life. In addition to pharmacological therapy and surgical intervention, botulinum toxin A (BoNT-A) has been widely utilized in NLUTD. The therapeutic efficacy of detrusor BoNT-A injections for neurogenic detrusor overactivity due to spinal cord injury (SCI), multiple sclerosis, or other central nervous system lesions, such as cerebrovascular accident, Parkinson disease, early dementia, and pediatric NLUTD due to myelomeningocele, has been well established, with repeated BoNT-A injections every 6 to 9 months being necessary to maintain its therapeutic effects. Urethral BoNT-A injection can decrease urethral sphincter resistance and facilitate efficient voiding in patients with NLUTD who wish to preserve self-voiding. Detrusor BoNT-A injection can also decrease the occurrence of autonomic dysreflexia in patients with SCI, even after failed augmentation enterocystoplasty, with additional benefits including reduced UTI episodes and preserved renal function with repeated injections. However, this treatment does have some side effects. Complete informed consent for BoNT-A injection therapy with full disclosure of its potential complications should therefore be obtained before this procedure is undertaken.

Collaboration between dentists and otorhinolaryngologists in treating temporomandibular joint syndromes

Introduction: The mandibular articulation is a complex system involving muscles, tendons, ligaments and innervation and it can cause pain or discomfort that should not be overlooked. Pathological changes in the joint can reduce the patient’s quality of life by affecting his ability to eat and speak. Objectives: The aim of this study is to show that the collaboration between dentists and otorhinolaryngologists is the basis for good treatment of temporomandibular joint malfunctions. Materials and methods: A retrospective cross-sectional study was performed in patients with signs and symptoms of temporomandibular joint pain syndrome from 2018 to 2021 year. A total of 23 patients with clinical features consistent with TMS were enrolled. Patients were referred to dentists by otorhinolaryngologists. Results: The age range of patients was 23–67 years, mean of 45.30 ± 18.9 years. We found that 12 of them had bruxism, 6 abrasion due to stress and squeezing and 5 were with tooth damage. Almost 87% of them (20 of 23) had pain in the joint and masticatory muscles, 6 – clicking sounds, 3 – pain when opening mouth and chewing. Mouth opening was normal in 20 patients and 3 had impaired movement of the jaws. All patients were treated conservatively – soft foods, antiinflammatory drugs, 13,1% – occlusal spints, 21.7% – selective filing of the contact interferences, 65,2% – height adjustment with nonremovable structures. Along with the height adjustment we applied botulinum toxin injections and for pain – NSAIDs. Conclusion: Good collaboration is crucial for the diagnosis, quality and competent treatment of temporomandibular disorders, especially in patients with overlapping signs and symptoms.

An unusual adverse event of botulinum toxin injection in the lower face

In the lower third of the face, botulinum toxin A is used to obtain a more harmonious contour. The anatomical complexity of the face requires a more precise application of botulinum toxin. Describe the treatment of an unexpected effect after botulinum toxin A application in the lower third of the face. A 51-year-old female patient presented to our clinic for application of botulin toxin aiming to improve facial wrinkles and contour. 50U of botulinum toxin type A were applied to the upper third and 20U to the lower third of the face. The patient returned after 10days with a smile asymmetry and an excessive and unconscious lowering on the right side of the lower lip while laughing. So, 3U of botulinum toxin were applied to the center of the depressor labii inferioris muscle on the right side. The patient returned with a satisfactory correction of the smile asymmetry. Although treatments with botulinum toxin A are considered safe, unexpected results can occur. In our case, it probably occurred due to medial injection or diffusion of botulinum toxin A into depressor anguli oris muscle on the left side that may lead to paralysis of the left depressor labii inferioris muscle and downward hyperfunction of the unaffected right lower lip. The correction was made with a new injection of botulinum toxin A in the depressor labii inferioris hyperactive muscle at the right side.

Interocclusal Device Instrumented by Fiber Bragg Gratings: Case Study of Bruxism Treatment With Botulinum Toxin

The lasting effect of applying botulinum toxin type A in a patient with bruxism is analyzed using an interocclusal device instrumented by fiber Bragg grating sensors. The case study involves analyses of maximum bite forces and hyperactivity during sleep for a volunteer patient. In controlled, in vivo, assays, the bite force exerted by the patient is monitored when using the interocclusal device. A maximum bite force of ~38 N was obtained before the application of botulinum toxin. One month after the application, the force had reduced to ~20 N (i.e., by ~57%). By contrast, approximately two months after the application, the force had recovered to 90% of the initial value. In hyperactivity assays, the patient slept with the interocclusal device in position, with the biting activity monitored, before and after the application of botulinum toxin. Prior to the application of botulinum toxin, the mean force was ~28 N, which reduced by 25% after the application. In addition, the time interval between hyperactivity events almost doubled after the botulinum toxin application.

Treatment of acute dysmenorrhoea and pelvic pain syndrome of uterine origin with myometrial botulinum toxin injections under hysteroscopy: A pilot study

BackgroundAcute dysmenorrhoea in women which has been shown to be anatomically negative for endometriosis is a very common condition. It is frequently associated with Chronic Pelvic Pain (CPP) from uterine origin, including painful uterine contractions and deep dyspareunia. We call this association Painful Uterine Syndrome (PUS). Search strategyIn these women in failure of the usual treatments, we proposed a new treatment, with Uterine Toxin Botulinic injections (BTX) under hysteroscopy, as a compassionate option, among women in severe pain and therapeutic failure.Indeed, increased uterine contractility has been confirmed using cine magnetic resonance imaging in patients with acute dysmenorrhea and PUS.These findings, associated with the hypothesis of a possible uterine sensitization on the same model as irritable bowel syndrome (IBS) or painful bladder syndrome (PBS), led to the application of botulinum toxin (BTX) injections under hysteroscopy of the uterine myometrium in this indication. Material and methodsIn 2018, we conducted an open-label non comparative study, on 30 patients, with severe dysmenorrhea and PUS in therapeutic failure situation.All women had failure of usual treatments, with painkillers, anti-inflammatory drugs, contraceptive pill, menstrual suppressant therapy and a negative MRI and laparoscopy.The BTX units (200 IU of Incobotulinum-toxin A) were evenly distributed in the anterior and posterior myometrial wall under hysteroscopic control.Patients were reviewed between 8 and 12 weeks after BTX injections and then, at 6 months. Main resultsMedian VAS scores were significantly improved at 8–12 weeks follow up for dysmenorrhoea, deep dyspareunia, and pelvic pain outside of menstruation. Quality of life scores all improved dramatically. No major side effect has been reported in this pilot study.At 6 months, 12 patients (40 %), were given new injections for pain reccurence. But 14 patients (47 %), were still improved and did not require repeat injection at that time.4 patients, were improvement was not significant, did not ask for repat BTX injections. These patients were all positive for Pelvic Sensitization criteria. ConclusionsUterine BTX injection could be a very interesting therapeutic option in women with acute dysmenorrheoa and PUS in therapeutic failure. Only long-term randomised studies will be able to confirm that BTX injections are useful as a treatment for this condition. The randomised long-term study, Uteroxine, will shortly release its results.

A review on iatrogenic botulism

Background:With the flourishing application of botulinum toxin cosmetically and therapeutically is the emergence of iatrogenic botulism, a new type of botulism in addition to the traditional ones.Objectives:We aim at a comprehensive review of the clinical characteristics of iatrogenic botulism. Methods: The available publications are retrieved and studied.Results:Botulinum toxin blocks cholinergic transmission in the neuromuscular junctions and autonomic ganglia. The blockade can spread from the site of tissue injection to adjacent or sometimes far off structures, resulting in inadvertent disabling or even lethal effects. On literature review, weakness and dysphagia are the commonest complications of iatrogenic botulism, whereas ophthalmological and oropharyngeal symptoms are more prevalent in the cosmetic group and dyspnea in the therapeutic group. Antitoxin therapy is required in about 20% of the patients. Diagnosis of iatrogenic botulism is primarily clinical and should not be confused with the neurological diagnoses possessing similar clinical manifestations. Vigilance to the drug formulation, dosage, and administration during botulinum toxin injection are part of the preventive measures in minimizing the occurrence of iatrogenic botulism.Conclusion:While overlapping with the traditional types of botulism, iatrogenic botulism carries its unique clinical characteristics.

An Italian experience of a new personalized injective protocol (Botutouch) for botulinum toxin application in aesthetic medicine.

Botulinum toxin typeA (BoNTA) is widely used in aesthetic medicine as primary treatment to reduce facial wrinkles. Major unmet needs in the field of the injection techniques include dilution factor, injected volume and site. Since 2013, an innovative protocol has been developed in our clinic that works on a double dilution volume, identifies the injection site according to the specific anatomical-functional characteristics of each patient's musculature and applies a gentle massage to the injected area to optimize the toxin spread in the muscle. We retrospectively retrieved medical records of subjects that underwent aesthetic treatments in our outpatient Italian clinics from 2013. In cobotulinum toxin A was used in double dilution (100 AU in 5 mL of physiologic solution) and followed by a gentle massage after the injection to increase the distribution into the muscle. 197 subjects, most of them drug-naïve (81.7%), underwent 869 BoNTA treatments. On average, higher total units and volumes were applied in first visits or older subjects whereas the lower ones were preferred in following visits or younger subjects. As perceived by the patients, the effects of BoNTA lasted more than 6 months in about 38% of the cases. 95.9% of subjects declared to be satisfied,whereas 5.2% of adverse events were observed (4.8% hematoma, 0.2% ptosis, and 0.2% tenderness). To date, we offer a BoNTA treatment with the aim to maximize the results and consequent patient's satisfaction, with low incidence of complications.

Toxina botulínica para correção de assimetria facial pós AVC: relato de caso clínico

Introdução: A paralisia facial, é caracterizada pela incapacidade de movimentar os músculos faciais, que são responsáveis pela mímica facial, isso ocorre devido a uma lesão causada no nervo facial (VII) par de nervo craniano. No que diz respeito às causas de assimetrias faciais podem ser multifatoriais, podendo ser de origem congênita, adquirida (devido a lesões ou doenças), e de desenvolvimento. O uso da toxina botulínica, tem sido uma grande aliada uma vez que, proporciona benefícios para os tratamentos estéticos realizados por profissionais especializados. Objetivo: Dessa forma, o objetivo deste trabalho é relatar um caso clínico sobre a aplicação de toxina botulínica para correção de assimetria facial por paralisia pós AVC. Metodologia: Trata-se de um estudo de abordagem descritiva do tipo relato de caso clínico realizado em consultório odontológico na cidade de Maceió-AL. Relato de caso: Paciente NLFS, professora, sexo feminino, 45 anos, compareceu ao consultório no dia 21/01/2020 para fazer avaliação, a paciente relatou a seguinte queixa principal: assimetria facial devido a paralisia hemifacial no lado esquerdo do rosto. Conclusão: Todavia pode-se concluir que o tratamento com Toxina Botulínica-A foi eficaz para devolver estética, simetria, função e equilíbrio muscular à face da paciente.

Novel Application of Common Pharmacological Agents Nimodipine and Botulinum Toxin a on Traumatic Nerve Regeneration Following Microsurgical Repair: A Pilot Study

Novel Application of Common Pharmacological Agents Nimodipine and Botulinum Toxin a on Traumatic Nerve Regeneration Following Microsurgical Repair: A Pilot Study

Conservative treatment approach with botulinum toxin for cases of asymptomatic hypertrophy of the masseter muscle

Commonly related to parafunctional habits, Masseteric Hypertrophy represents an asymptomatic increase of the lower third of the face. Without gender preference, it has been shown to be prevalent in the second and third decades of life. As an alternative to surgical treatment, the use of Botulinum Toxin A has been increasingly effective in desired clinical results, such as reduced muscle thickness. This study aims to report the case of application of Botulinum Toxin A in an asymptomatic patient who presented bilateral hypertrophy of the masseter muscle, with 120 days follow-up of application where we observed improvement in facial aesthetics due to the reduction in volume of the muscles.

Clinical Applications of Botulinum Toxin in Oral and Maxillofacial Surgery

Botulinum toxin is a toxin produced by Clostridium botulinum bacteria. This toxin has eight known serotypes, among which both A and B are currently used in medicine. Its mechanism of action acts on inhibiting acetylcholine release at neuromuscular junctions following its local injection. This toxin has wide applications in dentistry in general and in oral and maxillofacial (OMF) surgery in particular. It can be applied in the management of temporomandibular joint disorders, neuropathic facial pain, facial nerve palsy, hypertrophy, and hyperactivity of masticatory muscles as examples. At present, it can be used in cosmetic treatment in the facial region to control wrinkles and asymmetry. The therapeutic effects of these toxins are temporary and relatively safe if used in an appropriate manner. This review was aimed to identify the uses of botulinum toxin in surgical and non-surgical treatment of OMF problems, the types of treatment available, and benefits of those treatments.

The application of botulinum toxin in the treatment of overactive bladder

Introduction:Urinary incontinence is an involuntary, decision-dependent urination that leads to partial or complete emptying of the bladder. The causes include overactive bladder syndrome, which is diagnosed on the basis of clinical symptoms, such as urgency to urinate, increased frequency of voiding, nocturia caused by increased reactivity of the detrusor muscle. Treatment of this condition includes, but is not limited to, pharmacotherapy, behavioral therapy, and pelvic floor exercises. It is also possible to use an innovative method of local injection of botulinum toxin into the bladder. It inhibits the release of acetylcholine, which results in the inhibition of the contractile activity of the detrusor muscle.The aim of the study: The purpose of the systemic review was to collect and analyze material of application of botulinum toxin in the treatment of urinary incontinence caused by overactive bladder.Material and methods: The work is a review of the literature on the use of botulinum toxin in the treatment of overactive bladder, published in 2002-2020.Description of the state of knowledge:The use of the described method gives long-lasting results compared to pharmacotherapy. In addition, it eliminates the side effects caused by drugs because the administration of drugs is reduced or discontinued. The use of botulinum toxin has many more benefits than simply improving the lives of people affected by urinary incontinence. When selecting the therapy, one should also pay attention to possible side effects resulting from the use of the described drug. Summary:Intravesical administration by means of botulinum toxin cystoscopy is a modern, safe, effective and minimally invasive method of treating urinary incontinence, possible on an outpatient basis, allowing to improve the urodynamic parameters. Side effects are very rare. The botulinum toxin serotype A used in this method is the most studied serotype used for therapeutic purposes. The conducted research shows that over 90% of women reported a clinically significant improvement in sexual function after using the method.

Comparison of Botulinum Toxin and Orthognathic Surgery for Gummy Smile Correction

Objective: This study aimed to compare the changes in the gummy smile in cases treated with botulinum toxin (BTX) application or orthognathic surgery. Methods: The retrospective sample comprised 61 subjects with gummy smile divided into 2 groups according to treatment received for gummy smile correction: 1-38 patients (6 male; 32 female), at a mean age of 28.60 years (s.d.=6.09), treated with BTX application; 2- 23 patients (7 males and 16 females) at a mean age of 29.59 years (s.d.=5.72) treated with orthognathic surgery. Patients from the BTX group refused to undergo orthognathic surgery. The measurement of the gingival exposure was performed in extraoral photographs of the posed smile, before and after treatment, and it was defined as the difference between the stomion of the upper lip and the incisal edge of the maxillary central incisor minus the height of maxillary central incisor obtained in the patient's dental casts. The data were obtained before (T1) and after treatment (T2) and change of gingival exposure with treatment (T2-T1). Intergroup comparison of gummy smile was performed with independent t-tests. Results: The surgical group presented significantly greater correction of the gummy smile with treatment than the BTX group. Conclusion: Gummy smile presented a greater improvement in patients treated with orthognathic surgery than with botulinum toxin application.

MULTIPLE ORAL PROCEDURES IN INJURED PATIENTS ADMITTED TO INTENSIVE CARE UNITS

A male patient, 27 years old and a victim of physical aggression, presented with severe, unconscious cranioencephalic trauma, with orotracheal intubation in mechanical ventilation, psychomotor agitation, and presence of sialorrhea. A healthy dentition and lingual piercing were observed, and the piercing was removed to prevent trauma in the oral cavity and in the orotracheal tube. The patient evolved with bruxism secondary to neurologic alteration causing lesions in the tongue and trauma in the orotracheal tube, causing a decrease in oxygen saturation and worsening of sialorrhea with an unsatisfactory response to anticholinergic pharmacologic treatment. We chose to install a mouth guard, low-level laser therapy application on the tongue, and later the application of botulinum toxin to the masseter and temporal muscles, and to larger salivary glands. Evaluation and dental therapy for patients in the intensive care unit are fundamental to prevent and treat oral lesions, providing greater patient comfort, and contributing to the control of nosocomial infections and shortening hospitalization time.

Botulinum Toxin in the Management of Hyperhidrosis and Other Salivary Conditions

The aim of this review is to summarise the most up-to-date literature on the application of botulinum toxin in hyperhidrosis and other salivary conditions, including sialorrhea, salivary leak and Frey’s syndrome. Surgeons performing this procedure should stay updated with the most recent evidence of its effectiveness for appropriate treatment planning and patient consultation. The use of botulinum toxin in hyperhidrosis provides symptom relief in most patients, with satisfaction rates of 80–100% in the majority of patients. Accidental infiltration of local musculature is the most common complication, providing a transient paralysis which is reversible. There has been an increasing body of evidence on the effectiveness of botulinum toxin in salivary gland conditions. This has been able to confirm and quantify its utility as a temporary symptom relief treatment, with minimal complications. For both conditions examined, there is a lack of literature comparing the effect of botulinum toxin to other treatment modalities. Botulinum toxin has a growing body of evidence in hyperhidrosis and other salivary conditions. Overall, it is a very safe treatment which provides symptom relief and increased patient satisfaction in most patients. During consultations, surgeons should highlight the need of recurrent applications and the risk of diminishing efficacy with continuous use.

Botulinum Toxin for the Head and Neck: a Review of Common Uses and Recent Trends

To provide ENT surgeons with an up-to-date overview of the common cosmetic and non-cosmetic uses of botulinum toxin (BoNT) in the head and neck. We present a narrative summary of the pharmacology and commercial preparations; principles of use; cautions, contraindications and adverse effects; common cosmetic applications; common non-cosmetic applications; and recent cosmetic trends in the use of BoNT type A. The cosmetic and non-cosmetic applications of BoNT in the head and neck have rapidly expanded in recent years, with excellent outcomes and considerable demand from patients. It is essential for ENT surgeons to have a good awareness of BoNT and its applications to complement their practices for the benefit of their patients. This narrative review provides a concise, comprehensive and up-to-date overview of BoNT applications in the head and neck for today’s ENT surgeon.

Assessment of laser-assisted delivery vs intralesional injection of botulinum toxin A in treatment of hypertrophic scars and keloids.

Keloids and hypertrophic scars could impair the psychological, physical, and cosmetic aspects of the patient's quality of life. Unfortunately, there is no curative treatment available till now. This study aimed to evaluate the efficacy and safety of intralesional vs topical botulinum toxin A combined with Fractional CO2 laser in the treatment of hypertrophic scars and keloids. Twenty patients with Keloids and hypertrophic scars were enrolled in the study. Each scar was divided into two halves, one subjected to intralesional injection of botulinum toxin type A once a month for 4 months and the other was subjected to four sessions of CO2 laser therapy at 1 month interval followed by topical application of botulinum toxin A. Significant improvement was noted in Vancouver Scar Scale in hypertrophic scars in laser group than intralesional botulinum toxin A. In keloid cases, the improvement was significantly higher with intralesional botulinum toxin A. Clinical improvement showed significant negative correlation with scar duration and size. Botulinum toxin A is a promising treatment for hypertrophic scars and keloids. The use of fractional CO2 laser as a mode of delivery enhanced the efficacy of botox in hypertrophic scars.

Nonaesthetic Applications for Botulinum Toxin in Plastic Surgery.

Since their introduction to clinical medicine in 1989, botulinum toxin injections have been used for many indications. First used for nonsurgical management of strabismus, botulinum toxin injections are now widely used in plastic and reconstructive surgery for aesthetic indications; however, nonaesthetic indications of botulinum toxin have grown tremendously over the past two decades and span numerous specialties, including urology, dermatology, ophthalmology, otolaryngology, gynecology, plastic surgery, general surgery, and neurology. The present review aims to highlight nonaesthetic indications of botulinum toxin that are most relevant to the plastic surgeon with an emphasis on evidence-based practice. A PubMed search with manual reference checking was conducted to find the most relevant and influential articles on the nonaesthetic uses of botulinum toxin within the realm of adult plastic surgery. Studies were then categorized into areas of use, and quality of evidence for each category was highlighted. Botulinum toxin has numerous nonaesthetic indications in plastic surgery, including for select pain-related disorders, skeletal muscle activity disorders, exocrine gland hyperfunction, wound healing, Raynaud phenomenon, abdominal wall reconstruction, and prosthetic breast reconstruction and augmentation. Although these indications have been widely reported, high-quality evidence supporting efficacy, optimal dose, and injection protocol with randomized controlled trials is lacking in many areas. Botulinum toxin is widely used in plastic surgery for a variety of nonaesthetic indications. Future studies should focus on investigating efficacy and best practice with high level of evidence research.

Dysphagia in cervical dystonia patients receiving optimised botulinum toxin therapy: a single-center retrospective cohort study

To explore the correlations of botulinum toxin (BT) therapy with dysphagia, we wanted to study a group of cervical dystonia (CD) patients with optimised BT therapy during a prolonged period of time to record their dysphagia frequency, severity and duration, to study potential risk factors and try to avoid it by BT application with ultrasound guidance. BT therapy of 75 CD patients (23 males, 52 females, age 60 ± 12 years, BT total dose 303.5 ± 101.5 uMU) was retrospectively analysed for 1 year. BT therapy was optimised prior to the observation period. Dysphagia was noticed by one fifth of the patients. In those patients, it only occurred in about one third of the injection series. It was never associated with a functional deficit and lasted several days to 2 weeks. It was not related to patient age or gender, BT total dose, BT dose in the sternocleidomastoid muscle, BT dose in the sternocleidomastoid and scalenii muscles, by BT therapy with bilateral sternocleidomastoid muscle injections or BT therapy with abobotulinumtoxinA. Ultrasound guidance was not able to prevent it. Further prospective studies will be necessary to study underlying dystonia associated swallowing abnormalities as a potentially predisposing factor.

ETHICAL AND LEGAL ASPECTS OF THE USE OF FAKE DRUGS FOR OROFACIAL AESTHETICS – A CASE REPORT

Introduction: Over the last decade, Botulinum Toxin (BT) gained space in the armamentarium of drugs used for orofacial aesthetics. The contemporary scenario of Dentistry led to new horizons within aesthetic treatments founded on the application of BT. Objective: This study aimed to report a case of fake type-A BT sold to a dentist on training for orofacial aesthetics. Material and methods: During a 16-hour training course, a dentist bought form a reference seller a “so-called” quality drug allegedly consisting of type-A BT. After suspecting of fake drug based on uncommon label and flask, the dentist sent images of the product to the laboratory responsible for registering the drug at the National Health Surveillance Agency (ANVISA). Results: The laboratory confirmed the fake drug. ANVISA blocked the commercialization, use and distribution of the product as well as made efforts to remove the available products from the market. Parallel police investigations were carried out and forensic expertise for drug profiling was accomplished – confirming the fake drug. Conclusion: This study drives attention to the possibility of existing fake drug commercialization to dentists dedicated to orofacial aesthetics, and the potential impact of this drugs if used in patients. Consequences might extend to penalties in the consumer relation interface, as well as in the criminal field as offense against public health.