Decreased utilization of component separation techniques over time in complex abdominal wall reconstruction following introduction of preoperative botulinum toxin A.

Botulinum toxin type A (BTX-A) is emerging as a promising intervention for refractory allergic rhinitis. This study evaluates its effectiveness in treating refractory allergic rhinitis. The primary outcome was total nasal symptom score (TNSS), while secondary outcomes included individual nasal symptom scores, quality of life (QOL), and adverse effects. Five trials involving 187 patients (mean age: 31.8 years) were included. BTX-A significantly improved TNSS at 4 weeks [SMD -2.07, 95% confidence interval (95% CI) -3.58 to -0.56; P < 0.001] and 12 weeks (SMD -2.42, 95% CI -4.22 to -0.62; P < 0.001). Neither comparison of BTX-A with triamcinolone injection nor oral cetirizine showed a significant difference in TNSS (SMD - 0.51, 95% CI -1.25 to 0.24; P = 0.18 and SMD 0.50, 95% CI -0.07 to 1.06; P = 0.08, respectively). In the BTX-A group, significant improvements were observed in rhinorrhea (SMD -2.18, 95% CI -3.74 to -0.62; P < 0.001), sneezing (SMD -1.88, 95% CI -2.60 to -1.15; P < 0.001), and itchiness (MD -1.57, 95% CI -2.45 to -0.69; P < 0.001) at 4 weeks, with these effects persisting up to 12 weeks. No serious adverse events occurred following BTX-A administration. BTX-A shows promise as an adjunctive therapy for refractory allergic rhinitis.

First- and second-line medical and surgical therapies for trigeminal neuralgia (TN) may have limited efficacy or tolerability in some individuals. In addition, even when these therapies are initially successful, efficacy frequently wanes over time. This narrative review presents medication options for intractable trigeminal neuralgia with a focus on new and upcoming therapies. Lacosamide, eslicarbazepine, and botulinum toxin are increasingly used for intractable TN, with recent studies demonstrating efficacy. Basimglurant and vixotrigine (BIIB074) are investigational agents currently or recently studied for treatment of TN. Intravenous (i.v.) sodium channel blockers, i.v. magnesium, multiple formulations of lidocaine, and sumatriptan can be used for acute treatment of intractable TN. Multiple medical therapies exist for treatment of intractable TN, with newer options demonstrating efficacy in recent studies. Investigational agents are currently being studied as potential future options for management of intractable TN.

Psychological outcomes of botulinum toxin treatment for facial nerve palsy sequelae: A retrospective analysis of anxiety and depression.

Preoperative use of botulinum toxin for the closure of large abdominal wall defects: a case series

Awake Intravesical Botulinum Toxin Injection in the Outpatient Clinic Setting Is Feasible and Well Tolerated by Pediatric Patients With Neurogenic Bladders.

Cold intolerance after hand injury: Mechanisms, measurement challenges, and implications for clinical management.

Current Perspectives on Pectoralis Minor Syndrome: A Narrative Review.

Lack of head-to-head comparative safety and efficacy data for abobotulinumtoxinA (aboBoNT-A) and onabotulinumtoxinA (onaBoNT-A) represented an important gap for informed spasticity management. This study compared the safety and efficacy of aboBoNT-A and onaBoNT-A for upper limb spasticity (ULS). DIRECTION (NCT04936542), a phase IV, randomized, double-blind, crossover study, involved 72 sites. Patients stratified by botulinum toxin A status (naïve/non-naïve) were randomized (1:1) to aboBoNT-A 900U followed by onaBoNT-A 360U (one cycle each), or vice versa. Muscles (wrist/finger flexors, biceps brachii) were injected with a fixed volume, using instrument-guided injection techniques. Participants fulfilling retreatment criteria received a second cycle at Week 12; otherwise, they were reassessed every 4weeks (to Week 24) until requiring retreatment. Primary analyses tested non-inferiority based on treatment-emergent adverse events (TEAEs) from injection to Week 12 using a 5% non-inferiority margin [non-inferiority demonstrated if upper bound of the 80% confidence interval (CI) of the adjusted difference in TEAE rates was < 5%]. Secondary analyses compared duration of response based on time to symptom re-emergence. Overall, 464 patients [mean (standard deviation) age 56.8 (13.1) years, 34.1% female] were randomized (aboBoNT-A → onaBoNT-A [n = 231]; onaBoNT-A → aboBoNT-A [n = 233)]. Baseline characteristics were similar in both sequence arms. Adjusted rate of TEAEs for aboBoNT-A (20.3%) was non-inferior to onaBoNT-A (23.0%); adjusted difference (aboBoNT-A-onaBoNT-A) was - 2.7% (80%CI - 6.2%, 0.9%). Adjusted mean duration of response was 99.3days for aboBoNT-A and 96.3days for onaBoNT-A; adjusted difference of 3.0 (80%CI 0.2, 5.9) days favoring aboBoNT-A (p = 0.17; statistically significant under the pre-specified α = 0.20 framework). Longer duration of response with aboBoNT-A versus onaBoNT-A was seen across most subgroups over a fixed-interval follow-up. In this first head-to-head study of aboBoNT-A and onaBoNT-A in ULS, the aboBoNT-A TEAE rate was non-inferior to onaBoNT-A. At 90% of the maximum unit dose for adult ULS in the approved label for each formulation, duration of response was 3days longer with aboBoNT-A than onaBoNT-A. These findings may support informed therapeutic decision-making. ClinicalTrials.gov: NCT04936542; EudraCT: 2023-509196-16-00.

Strabismus surgery is traditionally performed under general anesthesia (GA), however this is not safe or suitable for many patients. There has been increasing interest in strabismus surgery under local anesthesia (LA), however large datasets comprehensively exploring what is feasible under LA are lacking. We identified 440 operations performed under LA at a tertiary eye center over a 5-year period from 2020 to 2024 and performed a retrospective review of surgical notes for all cases. Further in-depth analysis of anaesthetic notes was performed for a subset of 153 LA cases and compared to 92 representative GA cases from the same time period. This study provides an extensive patient cohort to show that even complex or re-do strabismus surgery can be safely and successfully performed under LA with appropriate sedation. The most common indications for LA were weekend scheduling constraints, patient preference, and co-morbidities. The widespread use of sedation permitted more complex surgery than has previously been reported with LA alone; this included vertical recti and re-do operations, as well as challenging strabismus procedures such as Yokoyama and Harada-Ito surgery. Only one case required conversion to GA due to pre-operative anxiety, with a very low incidence of other complications. LA with sedation significantly outperformed GA in several parameters including incidence of oculo-cardiac reflex (0% vs. 42.4%), post-operative opioid requirements (0.6% vs. 13.0%), post-operative anti-emetic requirements (7.2% vs 13.0%) and median hospital stay after surgery (119 vs. 174 minutes). The LA cohort also had a higher average age (54.7 vs. 41.9) and BMI (28.5 vs. 26.2). Strabismus surgery under LA with sedation is a safe and well-tolerated option, including in patients at higher anaesthetic risk for GA. More widespread use may help to expand the eligible patient population, allowing access to corrective surgery for those who would otherwise only be eligible for botulinum toxin in an outpatient setting. We also demonstrate the potential to reduce intra- and post-operative complications and optimize theater efficiency and utilization of resources in a day case setting.

Neuropathic pain (NP) remains a therapeutic challenge due to the limited efficacy of conventional pharmacotherapies. This review aims to systematically consolidate the pathogenic role of the P2X7 receptor (P2X7R) in NP and to evaluate emerging translational strategies targeting this channel, including natural compounds, selective antagonists, drug repurposing, cell-based therapies, and neuromodulation. Recent studies indicate that P2X7R is highly expressed in the spinal cord or dorsal root ganglia across multiple preclinical models of neuropathic pain, including peripheral nerve injury, diabetic neuropathy, chemotherapy-induced neuropathy, and postherpetic neuralgia, underscoring its pivotal role in the pathogenesis of neuropathic pain. In preclinical studies, targeting P2X7R with agents such as Brilliant Blue G, A-438079, botulinum toxin A, mesenchymal stem cell-derived secretomes, and high-frequency spinal cord stimulation produces marked, P2X7R-dependent analgesic effects. P2X7R stands out as a promising therapeutic target for neuropathic pain. Future priorities should focus on optimizing P2X7R-targeted pharmacodynamics, developing CNS-penetrant oral antagonists, and exploring combination strategies to maximize analgesic outcomes in NP patients.

Refractory overactive bladder (OAB) lacks formal definition and is poorly understood. Its management requires patients to choose an invasive treatment, including intravesical botulinum toxin A (BOTOX®), sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS), which have varying rates of efficacy and side effects. These decisions can be complex for patients to make, especially within the time constraints of outpatient clinic appointments. A new patient decision aid (PDA) has been developed to support patients during this shared decision-making process. This study assesses decisional conflict scores and patient satisfaction in those who use a novel PDA for refractory OAB. Consecutive new patients with refractory OAB were provided with the PDA prior to decision-making. Patients then had a virtual follow-up appointment to assess their decisional conflict, using a validated scale. The total decisional conflict score was calculated. Treatment choice and free-text feedback were also analysed. Twenty-five patients were included. Following use of the PDA, a range of treatment choices were made, including SNM (n = 6), PTNS (n = 10), BOTOX® (n = 6) and continuation with medical therapy (n = 3). Overall, decisional conflict was low, with 100% of patients having a score of less than 25. Subscores suggested improved patient understanding, with the PDA increasing clarification. Introduction of this novel PDA, in those requiring treatment for refractory OAB, was associated with low decisional conflict and positive patient feedback. This supports its use in shared decision-making, empowering patients to make an informed and individualised choice regarding their treatment.

Bruxism is a complex condition characterized by excessive activity of the masticatory muscles, often associated with pain, sleep disturbances, and reduced quality of life. Botulinum toxin injections into the masseter muscle have emerged as a promising treatment option. To assess the effectiveness of masseter botulinum toxin injections on bruxism severity, pain intensity, and sleep quality over a 6-month follow-up period. This prospective study involved 80 patients diagnosed with bruxism. Clinical outcomes were evaluated using the Beck Depression Inventory (BDI), Visual Analog Scale (VAS), and Pittsburgh Sleep Quality Index (PSQI) at baseline and at 1, 3, and 6 months. Repeated measures ANOVA was used for statistical analysis. Significant improvements were observed in all outcome measures. BDI scores decreased from 20.8±4.3 at baseline to 4.3±1.5 at 1 month (P<0.001), with a partial rebound at 6 months. PSQI scores showed sustained improvement from 10.0±2.3 to 2.8±1.0 at 6 months (P<0.001). VAS scores also demonstrated significant reductions (P=0.004). Masseter botulinum toxin injection provides rapid, clinically significant relief of bruxism-related symptoms with lasting benefits, particularly for sleep quality.

To evaluate the effects of swallowing therapy and cricopharyngeus (CP) muscle surgery on upper esophageal sphincter (UES) opening, oral intake, and airway protection in patients with absent UES opening following neurological injury. Retrospective review of seven patients managed between September 2021 and July 2024 with absent UES opening confirmed by Modified Barium Swallow Study (MBSS). All patients underwent swallowing therapy followed by at least one CP-targeted intervention, including balloon dilation, botulinum toxin injection, and/or myotomy. Swallowing outcomes were assessed using the Functional Oral Intake Scale (FOIS), Mann Assessment of Swallowing Ability (MASA), Penetration-Aspiration Scale (PAS), and pharyngoesophageal segment (PES) opening scores from the Modified Barium Swallow Impairment Profile. CP-targeted surgeries were associated with improved FOIS, MASA, and PES opening scores. PAS scores did not change substantially, with six patients demonstrating values greater than or equal to 7. Patients who underwent CP-directed intervention within 6 months of injury demonstrated greater FOIS improvements than those treated later (3.25 vs. 0.33). CP interventions can facilitate improved bolus passage and oral intake in patients with absent UES opening following neurological injury. However, persistent aspiration risk remains despite improved mechanical opening, highlighting the need for continued swallowing therapy. Finally, earlier intervention may optimize outcomes, though further research is needed to refine treatment for this rare condition.

Background: Chronic anal fissure (CAF) is a common anorectal disorder characterized by severe pain during defecation and impaired quality of life. While lateral internal sphincterotomy remains the standard treatment, it carries the risk of incontinence. Botulinum toxin (BTX) injection has emerged as a minimally invasive alternative. Objective: To evaluate the efficacy and safety of BTX therapy in the management of CAF in a cohort of 60 patients. Methods: This prospective study included 60 patients diagnosed with CAF at department of colorectal surgery, Bangladesh Medical University from January 2024 to December 2025. BTX-A was administered via injection into the internal anal sphincter. Patients were followed for 12 weeks, with outcomes assessed in terms of pain relief, fissure healing, and adverse events. Results: Complete fissure healing was observed in 46 (76.7%) patients, while 10 (16.7%) showed partial healing, and 4 (6.6%) showed no response. Significant reduction in pain scores was reported at 2,4, and 8weeks post-treatment. Minor adverse events included transient incontinence in 4 patients (6.6%) and mild perianal discomfort in 8 patients (13.3%). No serious complications occurred. Conclusion: BTX therapy is a safe, effective, and minimally invasive treatment for CAF, providing substantial pain relief and high healing rates with minimal complications. It represents a viable alternative for patients at high risk of postoperative incontinence. J Rang Med Col.2026 Mar;11(1): 141-145

Postoperative urinary retention (POUR) is a frequent and clinically significant complication following stapled hemorrhoidopexy, often resulting in catheterization, prolonged hospitalization, and patient discomfort. Strategies to reduce POUR remain limited. Intrasphincteric botulinum toxin (BTX) injection may decrease internal anal sphincter tone and indirectly reduce urinary dysfunction. To evaluate the effect of intrasphincteric BTX type A injection on the incidence of POUR following stapled hemorrhoidopexy in a secondary analysis of a prospective randomized controlled trial originally designed to assess postoperative pain outcomes. In this double-blind, placebo-controlled trial, 68 adult patients with grade III-IV hemorrhoids undergoing stapled hemorrhoidopexy at two tertiary hospitals were randomized (1:1) to receive either 50 units of BTX A or placebo injected into the internal anal sphincter intraoperatively. The primary outcome was POUR, defined as failure to void within six hours postoperatively with a bladder volume > 400 mL on ultrasound requiring catheterization. Secondary outcomes included postoperative pain, gas incontinence, bleeding, and anal stenosis. POUR occurred in 30 patients (44.1%). The incidence was significantly lower in the BTX group compared with placebo (20.6% vs. 67.6%, P < 0.001). In multivariable logistic regression adjusted for age and sex, placebo treatment was independently associated with higher odds of POUR (adjusted OR 8.87, 95% CI 2.82-27.95; P < 0.001). No significant differences were observed in postoperative bleeding or gas incontinence. Intrasphincteric BTX injection significantly reduces postoperative urinary retention following stapled hemorrhoidopexy and may represent an effective perioperative strategy to improve surgical.Registration: IRCT20130826014483N12; Registered 25 June 2025 (Retrospectively registered).

Purpose To evaluate the changes in aberrometry values on corneal topography and the function of the meibomian glands following therapeutic Botulinum toxin type A injections in patients with blepharospasm and hemifacial spasm. Materials and methods This retrospective interventional study included 24 eyes of 17 patients treated with Botulinum toxin type A for blepharospasm and hemifacial spasm. Corneal topography and meibography were performed before treatment and at 1 month. Results Botulinum toxin type A was injected bilaterally in seven patients and unilaterally in ten patients, totaling 24 treated eyes. There were no significant differences between pre- and post-injection measurements of flat keratometry (K1) (p = 0.585), steep keratometry (K2) (p = 1.000), mean keratometry (Kmean) (p = 0.809), corneal astigmatism (p = 0.641), astigmatism axis (p = 0.647), central corneal thickness (p = 0.631), anterior chamber depth (p = 0.127), and anterior chamber volume (p = 0.747). However, the root mean square of higher-order aberrations (RMS-HOA) (p = 0.018) and RMS-quadrafoil (Z4 4) (p = 0.012) significantly increased one month after the injection. Although increases were also observed in RMS-coma (Z3 1) (p = 0.225), RMS-trefoil (Z3³) (p = 0.147), secondary astigmatism (p = 0.433), and RMS-spherical aberration (Z4 0) (p = 0.150), these changes did not reach statistical significance. After the injection, there was a statistically significant reduction in tear break-up time (TBUT) (p = 0.041), Ocular Surface Disease Index (OSDI) score (p = 0.041), and the area of the meibomian glands (mm2) (p < 0.001). Conclusion Botulinum toxin A injection into the orbicularis oculi in both groups may decrease meibomian glands and tear function, increasing corneal aberrations and reducing visual quality after 1 month.

Managing Voice-Related Issues in Laryngectomized Patients With Voice Prosthesis: A Troubleshooting Algorithm for Rehabilitation.

Expert Consensus of China on Laryngeal Contact Granuloma: A Modified Delphi Study.

Botulinum toxin type A (BoNT-A) is widely used in aesthetic medicine to treat dynamic facial rhytides. Despite its well-established safety and efficacy, BoNT-A injections often induce discomfort and anxiety owing to injection-related pain, especially in sensitive facial areas. Although topical anesthetic creams are commonly employed to alleviate pain, they have limitations, such as delayed onset and local side effects. Mechanical analgesic devices, based on the gate control theory of pain, have emerged as promising non-pharmacological alternatives. In this prospective, single-center, split-face study, 80 adult patients undergoing upper-facial BoNT-A injections between May 2024 and August 2025 were enrolled. Each participant received a topical anesthetic cream on one side of the face and a Shot Blocker-like mechanical analgesic device on the contralateral side. All injections were administered by a single experienced physician. Pain levels were assessed immediately post-injection using a visual analog scale (VAS, 0-10) by a blinded evaluator. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, Spearman correlation, and Mann-Whitney U tests. Effect sizes were reported using Cohen's dz and Cliff's Δ. Mean VAS scores were significantly lower with the mechanical device (3.19 ± 1.08) than with the topical cream (4.14 ± 1.30) (p < 0.001). The intra-individual mean difference (0.95 ± 1.41) favored the mechanical device. Spearman's correlation indicated that higher pain scores with the cream correlated with greater relative benefit from the device (ρ = 0.664, p < 0.001). Patients with higher baseline pain (VAS ≥ 4 on the cream side) experienced significantly greater pain reduction (p < 0.001). A shot blocker-like mechanical analgesic device is more effective than a topical anesthetic cream in minimizing pain during BoNT-A injection into the upper face. Its immediate analgesic effect, absence of pharmacologic side effects, and ease of use make it a valuable adjunct in aesthetic practice, particularly for patients with pain sensitivity. Further studies are warranted to validate these findings in broader populations and different anatomical regions. 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.