Application Of Botulinum Toxin Research Articles

Emerging off-label esthetic uses of botulinum toxin in dermatology.

Botulinum toxin is a neurotoxic protein produced by Clostridium botulinum, the bacterium responsible for botulism. Botulinum toxin was first used for therapeutic indications in the 1970s for the treatment of strabismus. With greater understanding of its underlying physiology and safety profile, the use of botulinum toxin has now expanded to a range of cosmetic and medical indications. We performed a systematic review of current literature on the applications of botulinum toxin on off-label esthetic uses. Electronic databases were searched for original published studies including randomized trials, observational or cohort studies, as well as relevant case reports. To add to the body of evidence, our review summarizes and synthesizes key study characteristics, results, and level of evidence for each use case. Although the body of evidence remains weak, there is increasing support for the use of botulinum toxin in emerging off-label esthetic uses of botulinum toxin in dermatology.

Is botulinum toxin a cause or a cure for headaches?

Botulinum toxin is used in the treatment of headache as well as cosmetic indications. In recent years, headache cases have been encountered after botulinum toxin injections for cosmetic purposes. However, no clinical studies have been conducted on this seemingly paradoxical issue. In our study, the aim was to evaluate the frequency of occurrence of headache and its clinical features in patients who had undergone botulinum toxin application for cosmetic purposes. A total of 186 patients who were treated with onabotulinum toxin A for cosmetic purposes in our clinic between January 2019 and January 2021 were retrospectively screened, and the clinical and demographic characteristics of the patients who reported headache complaints were examined. Headache was reported in 19 (10.2%) of the 186 patients included in the study. Of the 19 patients who reported headaches, 17 (89.4%) had the onset of the complaint within the first 24h, the complaint was resolved within the first 3days in 16 (84.2%), and 12 (63.1%) reported spontaneous regression without the need for painkillers. The rate of development of headache complaints after the procedure was found to be statistically significantly higher in patients diagnosed with hypertension (p=0.000) and patients treated for bunny line (p=0.016). Ten patients (52.6%) described constant, 17 patients (89.5%) had diffuse, and 11 patients (57.9%) had throbbing-type headaches. Botulinum toxin application causes diffuse, constant, throbbing-type headaches that start in the early period and ends within a short time without the need for treatment.

Deep brain stimulation in primary Meige’s syndrome: a successful case report

Introduction: Meige’s Syndrome is a rare focal dystonia disorder characterized mainly by blepharospasm and orofacial dystonia. Dystonia is identified as a movement disorder, with abnormal involuntary movements and postures, caused by sustained or intermittent muscle contractions. Its pathophysiology is not fully elucidated, but it is known that its evolution is due to an abnormal excitability of the sensorimotor cortex and the interneural pathways of the brainstem, a genetic predisposition and environmental factors. Treatment includes various interventions, ranging from conservative approaches to invasive surgical procedures. Oral medications such as anticholinergics, dopamine antagonists and GABA receptor agonists shows positive results, also botulinum A injection can be used as treatment. If any of those conservative alternatives are not providing the required results, deep brain stimulation (DBS) of globus pallidus interna (GPi) provides an invasive neuromodulation that has been presenting improvement of symptoms in individuals with previous failure in other forms of treatment. Objectives: The purpose of this case report is to show the effectiveness of treatment with deep brain stimulation of GPi in a patient with Meige Syndrome that has undergone several other approaches previously. Because it is a surgical procedure, there are risks of adverse effects, but most of them can be minimized or even stopped by the correct programming of the intracerebral electrodes. This case report shows that the deep brain stimulation of Gpi is more efficient than other treatments when well indicated, besides having a better index of improvement when compared to the stimulation of the subthalamic nucleus. The authors do not have any conflict of interests. Case report: A 66-years-old man started suffering involuntary contractions of the orofacial muscles associated with blepharospasm that impaired his quality of life. He was diagnosed with Meige syndrome by a neurologist specialized in movement disorders. Before starting the treatment, he was extremely depressed with suicidal ideas and his psycho-affective relationship with family deteriorated since those symptoms started. Therefore, he was under follow-up with a psychologist and psychiatrist, who prescribed antidepressants Duloxetin 30 mg 12/12 oral and Nortriptyline 25 mg 12/12 oral. The patient was unresponsive to the conventional treatment. He had pharmacological treatment with Levodopa, Trazodone and Lorazepam without benefits. He also underwent several botulinum toxin applications for one year and two eyelid lift surgeries, also without success. He was referred to a functional neurosurgeon, who proceeded with the Gpi-DBS implantation in the patient, in February 2021, with an ActivRC generator. The surgery was performed with the patient awake and bilateral microrecording was used to help locate the target. After 4 weeks of surgery and correct programming of the electrodes - 3387 from Medtronic, 130 Hz, 90 PW, 2.5 mA, 1.5 mm2 contact area and 1.5 mm interelectrode spacing, with rechargeable battery -, the patient evolved with an improvement of 80% of the symptoms he presented before the surgical procedure.

Multivariable passive ankle impedance in stroke patients: A preliminary study

Multivariable ankle mechanical impedance was estimated in four stroke survivors, in coupled dorsi- plantarflexion and inversion–eversion. We applied external torque perturbation with an ankle robot and used multi-input, multi-output stochastic system identification methods to estimate impedance, in both paretic and nonparetic limbs. Subjects were instructed to remain at rest throughout the four trials performed on each leg. Impedance projected onto the directions of maximum and minimum stiffness was fit to a 2nd order linear model, including inertia, viscosity and stiffness. For most trials, stiffness and damping in dorsi-plantarflexion are increased on the paretic side. However, for two subjects, overall impedance is not increased in the absence of sustained involuntary tonic contraction, registering values comparable to the non-paretic side. Thus, we speculate that the intrinsic properties of the paretic ankle remained unaffected at the evaluated pose. Spasticity (hyperflexive stretch reflex) would have systematically increased stiffness and damping, even in the absence of involuntary contraction. Hence, we speculate that these two subjects did not exhibit spasticity, while the remaining two subjects did, since impedance was increased, with no involuntary tonic muscle contraction. Regarding inversion–eversion, impedance in this direction remained unaffected by stroke. We evaluated two volunteers before and after the application of botulinum toxin. Surprisingly, ankle stiffness was not reduced, but anisotropy was normalized.

Effect and longevity of botulinum toxin in the treatment of gummy smile: a meta-analysis and meta-regression.

The aim of this systematic review is to synthesize the evidence on the effectiveness and longevity of the botulinum toxin in the treatment of individuals with excessive gingival exposure. The search was adapted to six electronic databases and gray literature. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool for Non-Randomized and Randomized Studies of Interventions. Meta-analyses and meta-regression were performed using random effects models. A total of 5247 articles were collected during the final search in the database, resulting in 17 articles included. There was a mean decrease of 3.42 mm [95% CI = -4.50 to -2.34; I2 = 97%] in the level of gingival exposure 2 weeks after the application of botulinum toxin. The application time explained 29.58% of the observed variance (p < 0.001), with a tendency for the effect size to decrease from the second week of application onwards, with values returning close to baseline levels in 24 weeks. Botulinum toxin is an alternative technique considered effective for reducing gummy smile, especially for gummy smiles up to 4 mm, with a longevity of at least 12 weeks, returning close to initial values within 24 weeks after application. The knowledge about the longevity and effectiveness of botulinum toxin in the treatment of gummy smile allows for a more adequate clinical planning for these cases, as well as for clinical decisions, as for prognostic factors.

Treatment of occipital neuralgia using onabotulinum toxin A.

To determine the effectiveness of botulinum toxin in a sample of patients diagnosed with greater occipital nerve neuralgia. Twenty-nine patients (28 females, 1male) were treated for greater occipital nerve neuralgia with onabotulinum toxin type A; the Visual Analog Pain Scale was used to determine pain severity at treatment and again 12weeks after application. Average doses of onabotulinum toxin type A of 18.66±6.44 U per nerve and 35.96±12.89 U per patient were utilized. Average pain severity among the sample was 9.81±0.89 prior to botulinum toxin application and 3.68±2.31 points (p<0.0001) twelve weeks after application. Pain frequency decreased from 29.93±0.37 to 12.17±11.05days with pain per month (p<0.0001). Six patients reported absence of pain after application (p=0.023). Dose did not correlate with the degree of clinical response observed, and no side effects were reported. Our findings suggest onabotulinum toxin type A is a safe and effective treatment alternative for patients suffering from refractory greater occipital nerve neuralgia.

Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study.

The abdominal wall expanding system (AWEX) was first applied in 2012 and published in 2017. This novel technique was developed to reconstruct complex incisional hernias and residual skin-grafted laparostoma after treatment of an open abdomen, when primary midline closure was impossible. The main aim was the anatomical reconstruction of the abdominal wall and the avoidance of dissecting techniques (component separation). Between 2012 and 2019, 33 patients underwent AWEX hernia repair in three certified hernia centers. The retracted abdominal wall was stretched with the AWEX system intraoperatively for approximately 30min. Hernia size was measured preoperatively, on CT, and intraoperatively. The gain in length on the lateral abdominal wall (decrease in width of the defect) after stretching and any residual midline gap were determined in the OR. 33 patients underwent AWEX procedures. Six cases were evaluated separately because of additional procedures (TAR, four cases) and preoperative application of botulinum toxin (two cases). The median (95% confidence interval) measured width of hernia defects was 13 (12-16) cm, the median gain in length on the lateral abdominal wall was 12 (10-15) cm. After median follow-up of 29 (12-54) months, one recurrence from the broken mesh was observed. No method-related complications occurred. Based on the 2017 and current results, the AWEX system represents an alternative or supplemental procedure to current techniques for complex abdominal wall reconstruction. The system proved again to be time-saving, safe, effective, and easy to learn. Further studies with enhanced technology are in progress.

Rheumatoid Arthritis Induced by Botulinum Toxin Type A: A Case Report and Review of the Literature

Introduction: Botulinum Toxin Type A (BoNT/A) is a bacterial toxin commonly used in cosmetic therapy. Although there has been a great deal of clinical and basic research on the potential therapeutic applications of botulinum toxin there are few reports on its clinical toxicity and side effects. Patient Concerns: A previously healthy 26-year-old woman developed joint pain and redness in her right toe, swelling in the posterior left foot and the interphalangeal joint of the right index finger, occasional shoulder pain, and morning stiffness for 30 minutes daily, 6 months after BoNT/A injection. Diagnosis: Laboratory testing showed elevated Rheumatoid Factor (RF), anti-cyclic citrullinated peptide (anti-CCP), C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR). Doppler ultrasound examination of the right hand and both feet showed synovial hyperplasia of the right wrist, right second proximal interphalangeal joint, both ankles, and right first metatarsophalangeal joint, as well as bony erosion in a left intertarsal joint. Magnetic Resonance (MR) examination for right hand showed multiple joint changes of right hand and wrist, which included synovium thickening and enhancement. She was diagnosed as rheumatoid arthritis. Interventions: BoNT/A injection was stopped. Methotrexate 10mg was given once weekly and hydroxychloroquine 0.2g was given twice daily with subsequent remission of arthritis. Outcomes: At 12 months from diagnosis, patient reported complete joints remission. Conclusions: This is the first report of rheumatoid arthritis caused by botulinum toxin injection, and we speculate on the mechanism of its occurrence in this paper. In addition, we systematically introduce the latest research results on the development mechanism of BoNT/A causing RA. This review suggests that it is necessary to further explore the specific mechanism of RA or osteochondral injury caused by BoNT/A, which will not only help to improve the current understanding of the potential toxic and side effects of BoNT/A in clinical application, but also promote the standardization of clinical application of BoNT/A.

Novel Applications of Non-Invasive Intravesical Botulinum Toxin a Delivery in the Treatment of Functional Bladder Disorders.

Although intravesical botulinum toxin type A (BoNT-A) injection for functional bladder disorders is effective, the injection-related problems—such as bladder pain and urinary tract infection—make the procedure invasive and inconvenient. Several vehicles have recently been developed to deliver BoNT-A without injection, thereby making the treatment less or non-invasive. Laboratory evidence revealed that liposome can carry BoNT-A across the uroepithelium and act on sub-urothelial nerve endings. A randomized placebo controlled study revealed that intravesical administration of liposome-encapsulated BoNT-A and TC-3 hydrogel embedded BoNT-A can improve urinary frequency, urgency, and reduce incontinence in patients with overactive bladders. A single-arm prospective study also revealed that intravesical administration of TC-3 hydrogel embedded BoNT-A can relieve bladder pain in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). We recently administered suprapubic energy shock wave (ESW) after BoNT-A intravesical administration in six patients with IC/BPS. Although pain reduction and symptom improvement were not significant, immunochemical staining showed cleaved synaptosome-associated protein 25 in the bladder after the procedure. This suggests that ESW can promote passage of BoNT-A across the uroepithelium. In conclusion, using vehicles to intra-vesically deliver BoNT-A for functional bladder disorders is promising. Further studies are necessary to confirm the efficacy and explore novel applications.

Botulinum Toxins in Medical and Cosmetic Dermatology

Background: Botulinum toxin (BoNT), a bacterially produced neurotoxin, is a mainstay in the dermatologic armamentarium. Although BoNT is commonly used to treated rhytides associated with ageing, it can be employed for a variety of other cosmetic purposes and medical disorders. Objective: In this review, the authors aim to describe the multitude of uses for BoNT in the dermatologic field. Materials and Methods: This manuscript was designed as a retrospective review of the on- and off-label applications of BoNT in dermatology.Results: In addition to treatment of rhytides, BoNT has been shown to decrease rosacea, menopause-associated flushing, and facial sebum production, while improving patient confidence in their appearance. Furthermore, BoNT has been successfully used to treat primary hyperhidrosis, hair loss, aberrant scarring, Raynaud’s phenomenon-associated vasospasm, as well as a variety of skin diseases. Side effects of BoNT include pain or discomfort associated with injections during treatment, bruising, asymmetry, and swelling. Patients are generally satisfied with clinical results after BoNT treatment. Conclusion: Dermatologists should be aware of all on- and off-label applications of BoNT to provide patients with timely and appropriate medical care. Further research must be completed to fully characterise the safety and use of BoNT for off-label purposes.

COST-EFFECTIVENESS OF THE APPLICATION OF BOTULINUM TOXIN VERSUS BIOFEEDBACK AS TREATMENT IN PATIENTS WITH ANISMUS

Abstract INTRODUCTION Anismus is a pathology that is responsible for up to 50% of constipation cases, there are mainly 2 treatments: biofeedback and the use of botulinum toxin, with similar results. Does the application of botulinum toxin have a better cost-effectiveness index compared to biofeedback as a treatment in patients with anismus? The objective is to establish whether the application of botulinum toxin as a treatment in patients with anismus represents a better cost-effectiveness index compared to biofeedback. MATERIAL AND METHODS A randomized prospective cost-effectiveness trial was conducted evaluating the effectiveness of biofeedback treatment compared to the application of botulinum toxin in patients with anismus. Patients were followed up at month 1, 3, and 6 after management. RESULTS A total of 9 patients were included, 4 in the botulinum toxin group and 5 in the biofeedback group. The efficacy of botulinum toxin was 75% at month 1 and 3 and 50% at month 6. The efficacy of biofeedback remained at 80% at 6 months. The expense for biofeedback treatment was $ 17,458.32 MXN compared to $ 7,846.08 MXN for botulinum toxin. CONCLUSION A decrease in the average cost of $ 9,612.24 MXN was obtained in favor of the use of botulinum toxin for the treatment of anismus.

Gastric Botulinum Toxin-A Application for Weight Loss Therapy.

The aim of this study is to share the results of gastric botulinum toxin (BTX) application in individuals who are overweight or type 1 obese without comorbidity. In this study, 13 patients were included who were enrolled for gastric BTX application for the first time. A total of 300 U of BTX-A (Allergan Botox ®1 vial 100 U) was diluted with 8 mL of 0.9% NaCl saline, and antrum (100 U to 8 spots), corpus (100 U to 8 spots), and fundus (100 U to 8 spots) regions were injected intramuscularly. Patients were given a 1200-calorie low-carb diet and this was followed for 6 months. Gastric BTX application was applied to 13 patients with a mean age of 40.9 ± 5.2 (85% female), a mean body mass index (BMI) of 28.41 ± 1.4 kg/m2 (26-31.6) and a mean excess weight of 10.1 ± 3.6 kg. As a result of the 6-month follow-up, only four patients (30.8%) were able to lose more than 50% of their excess weight (6-15 kg). Six patients (46.2%) could not lose any weight. There was an average decrease of 3.3 kg in the weight of patients before and after BTX application (P = .03). A mean decrease of BMI was detected, 1.17 kg/m2 (P = .032). It was concluded that the application of gastric BTX for weight loss does not provide effective results.

Application of Botulinum Toxin in Patients with Secondary Otalgia Caused by Bruxism.

AimThe aim of this study was to determine the effectiveness of botulinum toxin administration in patients who consulted the otolaryngology clinic with secondary otalgia caused by bruxism.IntroductionBotulinum toxin can be applied to the hypertrophic muscles in patients who suffer from facial asymmetry even though they do not experience pain. Injection intervals and the condition of the muscles should be monitored as botulinum toxin applications to the muscles may result in decreased muscle strength and chewing difficulties.MethodsThis prospective study was conducted with bruxism patients at Private Kesan Hospital otorhinolaryngology outpatient clinic between August 2019 and December 2019. The diagnosis was based on the anamnesis and physical examination of the patient. The Visual Analogue Scale was used to evaluate patients’ pain levels throughout the treatment.ResultsA total of 37 patients, between 19 and 51 years old, 22 (59.46%) females and 15 (40.54%) males, who consulted to the otolaryngology clinic in Private Kesan Hospital between August 2019 and December 2019 with a diagnosis of otalgia caused by bruxism were included in the study. Nine patients (24.3%) had facial asymmetry due to masseter muscle hypertrophy. The average age of the participants was 34.00 ± 9.13 years old. Two weeks after the application of botulinum toxin, patients’ complaints subsided. In patients with facial asymmetry, it was observed that asymmetry decreased after the 2nd month and noticeably improved after the 4th month.DiscussionBruxism should be considered in the differential diagnosis of patients with ear pain. Botulinum toxin can be applied in patients who do not respond adequately to classical treatments such as medical treatments, chewing training, neck and facial muscle relaxation techniques, psychological support, and dental splint applications.

Management of excessive gingival display using botulinum toxin type A: a descriptive study

Botulinum toxin is a protease used by the bacterium Clostridium botulinum that causes chemical denervation of skeletal muscles, producing a temporary weakening of muscle activity. Despite having a transitory effect, the application of botulinum toxin has been identified as an alternative for correcting an excessive gingival display (EGD). However, studies evaluating the maintenance of long-term results of botulinum toxin remain scarce. This study aimed to evaluate the effectiveness and duration of botulinum toxin type A in the treatment of anterior EGD. Botulinum toxin Type A was applied to 15 patients with EGD. The measurement was performed in triplicate, using a Castro Viejo dry point compass, between the central cervical portion of the upper lateral incisors to the lower portion of the upper lip, bilaterally. The measurements were performed before the application of the toxin and repeated on days 7, 14, 90, 120, and 180 after the procedure. The data were analyzed using repeated-measures ANOVA, followed by a Bonferroni. There was a statistically significant reduction between the measurements performed on the Baseline and seven days after the application of the botulinum toxin. After 180 days, approximately one-quarter of the patients in the sample did not presented EGD. Mild adverse effects were reported by 46.7% of the patients. The use of botulinum toxin type A was effective to treat EGD. After 180 days, it was still possible to observe a significant effect compared to the initial gingival exposure.

Protocolo para rejuvenescimento facial minimamente invasivo em idosos

Objetivo: relatar o caso clínico de tratamento de rejuvenescimento facial em paciente idosa por meio da indução percutânea de colágeno, uso de fios de polidioxanona (PDO), preenchimento com ácido hialurônico e aplicação de toxina botulínica. Esses procedimentos são minimamente invasivos, utilizados para amenizar as alterações faciais decorrentes do envelhecimento. Descrição do Caso: paciente de 76 anos, apresentou interesse por procedimentos estéticos faciais e os mesmos foram realizados sequencialmente, conforme o plano de tratamento. Iniciou-se com microagulhamento seguida da máscara de ácido retinóico e orientações de home care. Após 28 dias, foi realizada aplicação de 50U de toxina botulínica no terço superior da face, nos músculos prócero (6u), corrugadores de supercílio (8u), frontal (14u), orbicular dos olhos (18u) e nasal (6u). Seguido um mês, foi realizada a inserção de 8 fios de PDO no terço médio da face para lifiting facial, e após mais 30 dias a paciente foi submetida a aplicação de ácido hialurônico para preenchimento labial, de olheiras, região malar/zigomático e de bossa canina. Após 6 meses da realização da toxina botulínica, uma nova aplicação de 50U foi realizada nas mesmas regiões aplicadas anteriormente. Todos os procedimentos foram bem sucedidos e proporcionaram bem estar e rejuvenescimento para a paciente. Conclusão: os procedimentos estéticos sequenciais propostos restabeleceram características de jovialidade e resultaram em bem estar físico e emocional, repercutindo na melhora na qualidade de vida da paciente.&#x0D;

Persistent Idiopathic Dentoalveolar Pain. Literature Review and Clinical Case Treated with Intraoral Application of Botulinum Toxin

Persistent Idiopathic Dentoalveolar Pain (PIDAP) is an orofacial neuropathic pain, which can be difficult to diagnose and is usually accompanied by increasing anxiety from both the patient and the treating dentist. A case of a 38-year-old female patient is presented, and it is shown the diagnostic process and therapeutic approach. The interdisciplinary management accompanied by several pharmacological lines is highlighted: Botulinum toxin was used as an adjunctive treatment allowing it to decrease systemically administered medications dosing and therefore its possible side effects. This condition usually affects psychosocial aspects of the patient and has a major impact on his quality of life. It is very important before initiating an invasive clinical treatment, obtaining a clear differential diagnosis and assessing in some cases the presence of non-odontogenic pain, such as PIDAP.

Aplicação da toxina botulínica em pacientes do sexo masculino – relato de caso

Botulinum toxin is one of the most potent bacterial toxins, with recognized therapeutic action in the aesthetic treatment of facial rhythms. However, due to the fact that the treatment is of individual effect, taking into account personal characteristics, in particular, of the male sex, the correct diagnosis is necessary to indicate the best technique and dose, in order to provide an adequate treatment to these patients. The present work consists of a literature review, addressing diagnosis, planning and treatment of wrinkles in males, with a clinical case report. A 65-year-old patient with a major complaint of dynamic and static facial rhythms in the frontal, glabellar and periorbital regions. Application of botulinum toxin in the upper and middle third of the face. The treatment with botulinum toxin aims to provide the patient with a result of facial armony, improvement of aesthetics and self-esteem, leaving the face with a lighter and younger appearance, preventing and softening future wrinkles in the region.

Reabilitação total com porcelanas em paciente acometido por amelogênese imperfeita

Amelogenesis imperfecta (AI) is a disorder of genetic origin, linked to the amelogenin gene, which presents developmental abnormalities in the quantity and quality of tooth enamel. The main clinical problems are the extensive loss of dental tissue, occlusal problems, impaired aesthetics, tooth sensitivity and gingival inflammation. This study described a clinical case and the approach in the treatment of a patient with AI, with gingival plastic surgery, porcelain crowns on the posterior teeth, porcelain veneers on the anterior teeth and application of botulinum toxin to correct the gingival smile. AI is an anomaly with complex development and early diagnosis is essential for the conduct and success of the case, to improve aesthetics and function, preserving the characteristic tooth wear.

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.