Botulinum Toxin Injection Research Articles

Evaluation of the Information Content of YoutubeTM Videos in Turkish on Botulinum Toxin Injection Administered to the Masseter Muscle in the Treatment of Bruxism: A Cross-Sectional Study: Bruxism and Botox on Youtube

Objective:The study aims the evaluation the content on the YouTubeTM platform about botulinum toxin injection for the treatment of bruxism regarding information quality. Methods: The YoutubeTM database was scanned using the keyword "masseter botox." According to the study criteria, 33 videos were included and the number of views, likes, dislikes, comments, duration, and the number of days since uploading were recorded. According to their quality, the information content was divided into four groups (bad, poor, good, excellent). Shapiro-Wilk, Kruskal-Wallis, and post-hoc Tamhane-T2 tests were used to analyze the study data, and Fleiss Kappa analysis was used to evaluate the agreement between researchers. Statistical significance was determined as p<0.05. Results: According to the installer source, 19 videos were uploaded by doctors, seven by patients, five by doctors+patients, and two by other sources. Significant differences were obtained between the uploaded source and the duration of the video; the number of views, the number of likes, dislikes, comments, interaction index, and viewing rate were respectively p<0.001, p=0.035, p=0.003, p=0.008, p=0.002, p=0.007, and p=0.013. According to the information content, 14 videos were bad, 15 were poor, and four had good information. A significant difference was observed between the number of comments (p=0.016) and video duration (p=0.029) regarding the information content quality. Conclusion: The results have indicated that YouTubeTM content cannot be a reliable source of information. Experts should recommend videos that meet specific standards to patients and produce content that provides accurate information in the absence of this content.

Challenges and Advances in the Diagnosis and Management of Neurogenic Thoracic Outlet Syndrome: A Comprehensive Review.

Neurogenic thoracic outlet syndrome (nTOS) is caused by brachial plexus compression in the thoracic outlet. It accounts for 85%-95% of thoracic outlet syndrome (TOS) cases, which may also be caused by compression of the subclavian artery and vein. Compression occurs in the interscalene triangle, costoclavicular space or subpectoralis minor space, with congenital anomalies and repetitive overhead activities as contributing factors. Diagnosis is challenging due to overlapping symptoms with other conditions. Patients commonly report pain, numbness, tingling and weakness in the neck, shoulder and arm, exacerbated by arm elevation. Symptoms related to nTOS may manifest in the distribution of the upper (C5-C6), middle (C7) and lower plexus (C8-T1). Although widely used, provocative tests have varying degrees of sensitivity and specificity and may have high false-positive rates, complicating the diagnosis. Patterns on electrodiagnostic studies provide key diagnostic clues, such as reduced sensory response in the medial antebrachial cutaneous nerve and low compound motor action potential in the median nerve. Imaging techniques like magnetic resonance imaging (MRI), alongside procedures like diagnostic and therapeutic anterior scalene blocks, assist in identifying anatomical abnormalities and predicting surgical outcomes. Management of nTOS involves lifestyle changes, physical therapy, medication and botulinum toxin injections for symptomatic relief. Surgical options may include supraclavicular, transaxillary and infraclavicular approaches, each offering specific benefits based on patient anatomy and surgeon expertise. Minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS) and robotic surgery, enhance exposure and dexterity, leading to better outcomes. Future research should focus on developing precise diagnostic tools, understanding nTOS pathophysiology, standardising diagnostic criteria and surgical approaches, comparing long-term treatment outcomes and exploring preventive measures to improve patient care and quality of life. Level of Evidence: Level V (Therapeutic).

Comparison of quality of life after bladder augmentation in patients previously treated with intradetrusor botulinum toxin A for neurogenic detrusor overactivity

PurposeTo compare the quality of life (QoL) in the same patients first treated with botulinum toxin A (BTA) injections for neurogenic detrusor overactivity (NDO) and then with bladder augmentation (BA). MethodRetrospective study of patients who had BA after BTA treatment between January 2012 and December 2022. Qualiveen Short Form questionnaires and a 7-level Likert/PGI-I scale to answer the question “How would you describe your quality of life after surgery compared to when you felt your best with BTA injections?” were collated and analyzed. ResultsFifty-two BAs for neurogenic bladder (NDO or low compliance) were performed in patients with a median age of 43years [33; 52] previously treated with BTA. After a median follow-up of 33.5 [13.8; 54.3] months, the median Qualiveen-SF global score after BA was significantly higher than that obtained at best BTA efficacy (1.63 [1; 2.63] vs. 2.63 [1.88; 3], P=0.012), as were the scores for the fear, constraints/restrictions and limitations/inconvenience domains. The median PGI-I score was +3 [2; 3] (truly better QoL) and 85.4% of patients reported a QoL after BA superior to the best QoL under BTA. ConclusionBA provides a greater range of QoL improvement than BTA injection for patients who have experienced both treatments. Long-lasting effects and absence of need to perform iterative retreatment were the main reasons. Level of evidence4.

Raynaud's Phenomenon: A Current Update on Pathogenesis, Diagnostic Workup, and Treatment.

Raynaud's phenomenon (RP) is a condition characterized by episodic, excessive vasoconstriction in the fingers and toes, triggered by cold or stress. This leads to a distinctive sequence of color changes in the digits. Pallor indicates reduced blood flow due to oxygen deprivation, while erythema appears as reperfusion. RP can be primary, with no identifiable underlying cause, or secondary, associated with other conditions. These conditions include autoimmune diseases, most commonly systemic sclerosis, vascular diseases; and neurological conditions. While the exact cause of RP remains unclear, genetic and hormonal (estrogen) factors are likely contributors. The pathogenesis of RP involves a complex interaction between the vascular wall, nerves, hormones, and humoral factors, disrupting the balance between vasoconstriction and vasodilation. In primary RP, the vascular abnormalities are primarily functional. However, in secondary RP, both functional and structural components occur in blood vessels. This explains why digital tissue damage frequently occurs in secondary RP but not primary RP. Diagnosis of RP is primarily clinical. Recent advancements in imaging techniques have aided in diagnosis and monitoring, but nail fold capillaroscopy remains the gold standard for distinguishing between primary and secondary RP. If there are signs of acute ischemic injury, vascular imaging, particularly preoperatively, is crucial to rule out other vaso-occlusive conditions. Management of RP focuses on alleviating symptoms and preventing tissue damage. Vasodilator medications are the first-line treatment when general measures like warmth and stress management are not sufficient. Dihydropyridine calcium channel blockers (CCBs), such as nifedipine, are commonly used for vasodilation. Phosphodiesterase-5 inhibitors and prostaglandin analogs are alternative options for patients who do not respond to CCBs or have ischemic tissue damage. Bosentan, an endothelin-1 receptor antagonist, has shown effectiveness in treating and preventing digital ulcers, especially in patients with multiple ulcers. For severe cases, botulinum toxin injections or sympathectomy surgery can be used to control RP symptoms. However, botulinum toxin injections require repeated administration, and sympathectomy's long-term effectiveness is uncertain. Fat grafting is a promising surgical therapy for promoting healing and preventing tissue injury.

What a Neurologist Should Know about Functional Anatomy for Botulinum Toxin Injections in the Head, Face, and Neck: A Practical Perspective

Since botulinum toxin (BoNT) was approved by the US Food and Drug Administration as a prophylactic treatment for chronic migraines in 2010, subsequent studies have shown that BoNT is effective in the management of chronic migraines due to its pain-relieving effects. Therefore, neurologists are increasingly utilizing BoNT as a therapeutic tool for chronic migraine. It is crucial to thoroughly understand the functional anatomy in the head, face, and neck regions to successfully administer BoNT injections in these areas. This review describes the complexity of muscles and their associated target nerves in the frontal, temporal, and occipital areas and serves as a resource for essential functional anatomy, with the goal of providing clinicians with a practical perspective on utilizing BoNT injections.

Systematic review of the histological and functional effects of botulinum toxin A on masticatory muscles: Consideration in dentofacial orthopedics and orthognathic surgery

IntroductionBotulinum toxin type A causes muscle paralysis and is widely used in the masticatory muscle for stomatognathic diseases, such as temporomandibular disorder, bruxism, or masseteric hypertrophy. Nonetheless, its muscular effect remains unclear. Better understanding could aid improved use and perhaps new indications, particularly in dentofacial orthopaedics and orthognathic surgery. MethodsThis systematic review explored the histologic and functional effects of botulinum toxin in animal and human masticatory muscles and was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The MEDLINE, Web of Science, and Cochrane Library electronic databases were searched for relevant articles. The inclusion criteria were human or animal masticatory muscle analysis after botulinum toxin injection(s) AND histological structural/ultrastructural analysis by optical or electronic microscopy OR functional effect analysis by bite force evaluation (occlusal force analyzer) and muscle activity (electromyography). ResultsOf an initial 1578 articles, 44 studies were eventually included. Botulinum toxin injection in the masticatory muscle altered its histological structure and functional properties. The human and animal studies revealed ultrastructural change, atrophy, and fiber type modifications of the masticatory muscles after one injection. Botulinum toxin decreased bite force and muscle activity, but recovery was uncertain. ConclusionsMuscle forces applied on the skeleton is a key feature of facial growth. Masticatory muscle paralysis changes mechanical stress on bones, which rebalances the force applied on facial bones. This new balance could benefit dental deformity or surgical relapse. Therefore, botulinum toxin could limit the orthognathic effect of the masticatory muscles in such patients. Given the uncertain recovery, multiple injections should be avoided, and usage should not deviate from established consensus.

Outcomes of a step-up approach to the treatment of neurogenic cough

IntroductionNeurogenic cough (NC) is thought to be related to sensory neuropathy in the hypopharynx and larynx. Defined as a cough persisting longer than 8 weeks refractory to standard therapy, it is a diagnosis of exclusion when other common etiologies (asthma, gastroesophageal reflux disease (GERD), medication side effects) are ruled out. It affects roughly 11 % of Americans and can negatively impact quality of life. MethodsFollowing institutional review board approval, we evaluated the medical records of adult patients seen at the University of Arizona's tertiary laryngology center from 2018 to 2023. Patients were included if their cough persisted for >8 weeks, and they either did not respond to prior proton pump inhibitor and asthma therapy or had GERD and asthma ruled out. These patients underwent a progressive escalation of therapy, which included neuromodulators with or without cough suppression therapy, superior laryngeal nerve (SLN) block, and laryngeal botulinum toxin injections. The primary outcome was patient-reported improvement in cough symptoms rated on a 1–5 scale: 1 = no response, 2 = mild improvement, 3 = moderate improvement, 4 = significant improvement, 5 = complete resolution. ResultsA total of 56 patients were included. Mean (SD) age was 64.6 (14.8) years, and 66 % were female. Overall, 42 patients (75.0 %) responded to treatment. Among responders, 7 (16.7 %) experienced mild improvement, 14 (33.3 %) experienced moderate improvement, 17 (40.5 %) experienced significant improvement, and 4 (9.5 %) experienced complete resolution of their cough.33 patients (58.9 %) were managed exclusively with neuromodulators ± cough suppression therapy; 27 responded, with an average response rating of 3.0 (SD = 1.2). 11 patients (19.6 %) failed medical therapy and underwent SLN block without subsequent botox treatment; 7 responded, with an average response rating of 2.5 (SD = 1.4). 9 patients (16.1 %) failed all previous therapies and underwent laryngeal botulinum toxin injections; 6 responded with an average response rating of 2.4 (SD = 1.3). The remaining 3 patients underwent cough suppression therapy alone, with 2 responding and an average response rating of 3.3 (SD = 1.7). ConclusionsNeurogenic cough can be effectively treated with a stepwise multimodal approach, including neuromodulators, cough suppression therapy, SLN block, and laryngeal botulinum toxin injections.

Comparison between botulinum toxin type A injection on masseter muscle only and additional injection on anterior belly of digastric muscle in sleep bruxism patients: A clinical trial.

This study aims to evaluate the effects on bite force and muscle thickness of the botulinum toxin (BoNT) injection for patients with sleep bruxism (SB) by comparing injections into the masseter muscle only and both the masseter and the anterior belly of the digastric muscle (ABDM) in a clinical trial. Twelve SB patients received BoNT-A injections using US-guided techniques into the masseter muscle only (Group A), while the remaining 12 SB patients received injections into both the masseter and ABDM (Group B). Bite force and muscle thickness were measured before injection, as well as 1 and 2 months after injection. The bite force and masseter muscle thickness decreased in both Group A and Group B before injection, and at 1 and 2 months after injection. However, there was no significant difference (p > .05, repeated measures analysis of variance) between the two groups, and there was also no significant difference in ABDM thickness (p > .05, repeated measures analysis of variance). This study is the first to assess the short-term effects of BoNT injected into ABDM for SB control. Results show no influence on SB reduction, suggesting the need for further research on BoNT's effectiveness in controlling intense ABDM contractions during sleep and assessing suprahyoid muscle potential impact on rhythmic masticatory muscle activity occurrence.

Sihler's staining of the anterior belly of digastric muscle for botulinum toxin injection.

The anterior belly of the digastric muscle (ABDM) is the target of botulinum toxin injection; however, anatomical considerations related to the injection point are absent. This study used Sihler's staining to analyze the intramuscular nerve distribution of ABDM to identify the most effective botulinum toxin injection points. We used 12 specimens from 6 embalmed cadavers in this study. The specimens were manually dissected to preserve the mylohyoid nerve and subjected to Sihler's staining. From the gnathion to and hyoid bone, the ABDM was divided into three equal parts, distinguishing the anterior, middle, and posterior thirds. Only a branch of the mylohyoid nerve entered the ABDM, and its entry point was located in the middle-third region in all cases. The nerve endings were concentrated in the middle third (100%), followed by the anterior third (58.3%) and were not observed in the posterior third. The landmarks used in this study (gnathion and hyoid bone) are easily palpable on the skin surface, allowing clinicians to target the most effective injection site (middle third of ABDM). These results provide scientific and anatomic evidence for injection points, and will aid in the management of ABDM injection procedures in clinical practice.

Levator Labii Superioris Alaeque Nasi Targeted Botulinum Toxin Injection for Treatment of Perinasal Facial Discomfort and Snarling.

Botulinum toxin has been increasingly studied and used for varying conditions, most notably, cosmetics. However, it has been shown that botulinum toxin demonstrates a high efficacy in treating spasticity disorders throughout the body, including the face. Facial spasms vary in pathophysiology, region, and severity. Some can be so severe that they can cause discomfort and emotional distress due to the involuntary facial expressions caused by the spasms. Most spasticity conditions are often treated with adjuvant therapy of oral muscle relaxants and analgesics depending on severity. However, these treatments impose risks of varying adverse effects from sedation, hypotension, and if chronic use, more severe effects such as central nervous system complications or QT prolongation. In addition, if spasms are localized, the muscle relaxant's mechanism is not targeted, leading to unnecessary systemic use. That being said, a more targeted and manageable treatment such as botulinum toxin presents itself as a potential option for patient's physical condition and everyday life quality. Our case presents a 62-year-old male, with a chronic history of localized, idiopathic spasms and discomfort within the Levator Labii Superioris Aqulae Nasi region. The patient had no history of previous neurological disorders, and imaging was unremarkable. The patient had been treated over the past 13 years with varying oral therapeutics including Cymbalta, Ibuprofen, and cyclobenzaprine with limited improvement, but presented to the clinic seeking a different treatment plan, as the adverse effects from the muscle relaxants were impeding his everyday activities. The patient was also experiencing significant pain and emotional stress due to the spasms. The risk and benefits of treatment options were discussed and the patient decided to move forward with botulinum injections. After the first injection, the patient reported his pain had significantly improved and was relieved to be off of chronic pain medications. Our case demonstrates, what increasing literature further also supports: botulinum toxin is becoming a potential effective treatment for a breadth of spasticity disorders with a more targeted mechanism, and more manageable treatment plan, while simultaneously improving the patient's quality of life.

The Use of Botulinum Toxin for Nasal Esthetics: A Systematic Review.

Physical attractiveness is commonly evaluated based on facial appearance, with the nose being the most noticeable feature. Botulinum toxin injection is a less invasive method for enhancing nasal esthetics, which can address minor nasal imperfections through relaxing muscles. To fully understand the uses of botulinum toxin in the nose area, a thorough review of the available information is necessary. We aimed to conduct a systematic review of literature to evaluate the effects and clinical application of botulinum toxin for nasal esthetics. We searched PubMed, Scopus, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases up until May 2023 to identify studies investigating the use of botulinum toxin for cosmetic enhancement in the nose area. Data was extracted from the selected studies regarding the baseline characteristics, type of botulinum toxin used, dosage, injection site, and outcomes. Initially, 1139 articles were found and 23 articles were included. The studies showed the usage of botulinum toxin can correct drooping nasal tips, dilated nostrils, minor post-rhinoplasty deformities, and high columellar show. It can also augment nasal dorsum, improve cleft lip-related deformities, and address other disorders related to the function and appearance of the nose. Botulinum toxin injection seems to be a safe and effective treatment option for individuals seeking to correct minor nasal defects. Further large-scale studies are recommended.

Sustainable Dynamic Wrinkle Efficacy: Non-Invasive Peptides as the Future of Botox Alternatives

Dynamic wrinkle reduction continues to challenge aesthetic dermatology, predominantly addressed through Botulinumtoxin (Botox) injections. Despite Botox’s robust efficacy with up to an 80% reduction in wrinkle visibility within just one week, its invasive administration and specific mechanism of soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complex inhibition prompt the exploration of safer, non-invasive alternatives. This review critically assesses recent innovations in non-invasive effects, with a focus on peptides and botanical extracts that exhibit a diverse array of mechanisms including SNARE complex inhibition, modulation of calcium and sodium channels, and interactions with acetylcholine receptors, contributing to their effectiveness in muscle relaxation on dynamic wrinkle approaches. Noteworthy peptides such as Argireline and SYN-Ake replicate the neuromodulatory effects of Botox, achieving up to a 52% reduction in wrinkles within four weeks without injections. Moreover, botanical extracts meet the rising demand for clean beauty solutions by enhancing skin elasticity and health through gentle yet potent mechanisms. However, the main concern with peptides is their low absorption rate, with only six clinical validations regarding Botox-like peptide anti-wrinkle efficacy available. These advancements not only deepen our understanding of cosmetic dermatology but also significantly influence market dynamics and consumer behavior, underscoring their pivotal role in redefining the future landscape of anti-aging effects.

The functional lumen imaging probe contractile response pattern is the best predictor of botulinum toxin response in esophagogastric junction outflow obstruction.

Esophagogastric junction outflow obstruction (EGJOO) is a heterogenous disorder in which the correct management strategy is unclear. We assessed whether functional lumen imaging probe (FLIP) topography data could select EGJOO, which would benefit from lower esophageal sphincter Botulinum toxin (Botox) injection. This was a single-center prospective study of adult patients meeting Chicago Classification (CC) v3.0 criteria for EGJOO. We assessed differences in pretreatment physiologic measurements on high-resolution manometry (HRM) and FLIP and other relevant clinical variables in predicting Botox response (>50% in BEDQ at 2 months). Sixty-nine patients were included (ages 33-90, 73.9% female). Of these, 42 (61%) were Botox responders. Majority of physiologic measures on HRM and FLIP and esophageal emptying were not different based on Botox response. However, a spastic-reactive (SR) FLIP contractile response (CR) pattern predicted a Botox response with OR 25.6 (CI 2.9-229.6) when compared to antegrade FLIP CR; and OR for impaired-disordered/absent CR was 22.5 (CI 2.5-206.7). Logistic regression model using backward elimination (p value = 0.0001, AUC 0.79) showed that a SRCR or IDCR/absent response and the upright IRP predicted Botox response. Response rates in tiered diagnostic groups were: (i) CCv3.0 EGJOO (60.9%), (ii) CCv4.0 EGJOO (73.1%), (iii) CCv4.0 + FLIP REO (80%), (iv) CCv4.0, FLIP REO, and abnormal FLIP CR (84.2%), and (v) CCv4.0, FLIP REO, and SR FLIP CR (90%). FLIP helps identify patients with EGJOO who are likely to response to LES Botox therapy. An abnormal FLIP contractile response pattern is the single-most important predictor of a Botox response.

Comparative evaluation of bioavailability of Botulinum toxin A complexed with Tizol (titanium glycerosolvate aquacomplex) versus pure Botulinum toxin A solution for bladder mucosa: an experimental study

Introduction. For the treatment of overactive bladder syndrome (OAB), injection of botulinum toxin A (BoNT-A) has been shown to be effective. However, there is a need for a less invasive method for administering BoNT-A, which could significantly expand the treatment options for OAB.Objective. To assess the impact of tizol on the absorption of BoNT-A by the bladder mucosa and compare it to the individual absorption of BoNT-A.Materials & Methods. Dialysis through the mucous membrane of the сalf bladder was used as an experimental model to study changes in bioavailability of BoNT-A complexed with tisol (BoNT-A + T) and pure BoNT-A solution during in vitro experiment. After dialysis, the BoNT-A concentration in both samples was determined using a spectrophotometer. Dialysis curves were plotted according to the data obtained. Kruvchinsky equilibrium dialysis method was used to determine botulinum toxin A bioavailability. The UV spectrophotometry method was used to determine the concentration of BoNT-A in the acceptor medium by reaction of BoNT-A with Benedict's reagent.Results. It was established that the maximum concentration of BoNT-A diffused into the acceptor medium from the blend of the test substance with tizol after nine hours. The area under the curve for dialysis of BoNT-A + T exceeds the area under the curve of pure BoNT-A by almost 20%, suggesting an improvement in the drug's bioavailability when blended with tizol.Conclusion. Based on our experiment, it was found out that the BoNT-A + T has greater bioavailability than a solution of pure BoNT-A. However, the diffusion rate of the component mixture is sufficiently low.

Preoperative visualization of the greater occipital nerve with magnetic resonance imaging in candidates for occipital nerve decompression for headaches

Occipital nerve decompression is effective in reducing headache symptoms in select patients with migraine and occipital neuralgia. Eligibility for surgery relies on subjective symptoms and responses to nerve blocks and Onabotulinum toxin A (Botox) injections. No validated objective method exists for detecting occipital headache pathologies. The purpose of the study is to explore the potential of high-resolution Magnetic Resolution Imaging (MRI) in identifying greater occipital nerve (GON) pathologies in chronic headache patients. The MRI protocol included three sequences targeting fat-suppressed fluid-sensitive T2-weighted signals. Visualization of the GON involved generating 2-D image slices with sequential rotation to track the nerve course. Twelve patients underwent pre-surgical MRI assessment. MRI identified four main pathologies that were validated against intra-operative examination: GON entanglement by the occipital artery, increased nerve thickness and hyperintensity suggesting inflammation compared to the non-symptomatic contralateral side, early GON branching with rejoining at a distal point, and a connection between the GON and the lesser occipital nerve. MRI possesses the ability to visualize the GON and identify suspected trigger points associated with headache symptoms. This case series highlights MRI's potential to provide objective evidence of nerve pathology. Further research is warranted to establish MRI as a gold standard for diagnosing extracranial contributors in headaches.

Enhancing Botulinum Toxin Injection Precision: The Efficacy of a Single Cadaveric Ultrasound Training Intervention for Improved Anatomical Localization.

Ultrasound guidance can enhance existing landmark-based injection methods, even through a brief and single exposure during a cadaveric training course. A total of twelve participants were enrolled in this training program, comprising nine physical medicine and rehabilitation specialists, one pediatrician, and two physician assistants. For each participant, one upper-limb muscle and one lower-limb muscle were randomly chosen from the preselected muscle group. Subsequently, participants were tasked with injecting both of their chosen cadaveric muscles with 1 mL of acrylic paint using a manual needle palpation technique, relying solely on their knowledge of anatomic landmarks. Participants then underwent a personalized, one-to-one ultrasound teaching session, lasting approximately five minutes, conducted by two highly experienced instructors. Following this instructive phase, participants were tasked with a second round of injections, targeting the same two muscles in the lower and upper limbs. However, this time, the injections were performed using anatomical landmarks and ultrasound guidance. To facilitate differentiation from the initial injections, a distinct color of acrylic paint was employed. When employing the anatomical landmark-based approach, the overall success rate for injections was 67%, with 16 out of 24 targeted muscles accurately injected. With the incorporation of ultrasound guidance, the success rate was 92%, precisely targeting 22 out of the 24 muscles under examination. There was an improvement in injection accuracy achievable through the integration of ultrasound guidance, even with minimal training exposure. Our single cadaveric ultra-sound training program contributes valuable insights to the utilization of ultrasound for anatomy training to help optimize the targeting of BoNT-A.

Treatment of myofascial pain and dysfunction using botulinum toxin A: a prospective study

Abstract Purpose We prospectively assessed the effects of botulinum toxin type-A (BTX-A) on primary and secondary outcomes in a population of refractory myofascial pain and dysfunction patients when conservative management had proven ineffective. Methods In this study, 26 patients with masticatory myofascial pain, who were refractory to conservative management, were enrolled prospectively to evaluate responses following the injection of botulinum toxin-A (BTX-A). Masseter muscles were injected with 30 units BTX-A and 20 units into the temporalis muscles. Pain, tenderness to palpation, and oral function were evaluated subjectively using a visual analog scale (VAS). Objective outcomes of maximal mouth opening (MMO) and reduction in total facial width after injection with BTX-A were measured. Participants were reassessed at 1-week, 1, 3, and 6-month intervals. A linear mixed-effect model was employed to assess the level of correlation (dependence) among different outcomes. Results Administration of BTX-A had a significant strong positive correlation with the reduction of pain (Phi = 0.641, P < 0.0005); significant strong positive correlation with increase in oral function (Phi = 0.738, P < 0.0015); significant strong positive correlation with increase in maximal mouth opening (Phi = 0.645, P < 0.0085); significant strong positive correlation with tenderness to palpation (Phi = 0.510, P < 0.0011); and significant strong positive correlation with reduction in facial width (Phi = 0.565, P < 0.0001). Conclusion The results from this study demonstrate that BTX-A administration may provide a safe and effective means to treat myofascial pain from hyperfunctioning masticatory muscles. It is not recommended to replace first-line treatment but may provide relief from chronic facial pain if properly administered in patients where standard conservative management has been unsuccessful.

The access and invasiveness-based classification of medical procedures to clarify non-invasive from different forms of minimally invasive and open surgery.

The rapid development of less invasive and traumatic medical procedures has resulted in a mixture of terms used to describe them, without any agreed definition for each. This is confusing to both medical professionals and patients and can lead to unrealistic patient expectations. The aim of this article is to show the current confused nomenclature and to suggest a new, simple classification based on access and invasiveness (AI) that can be applied to any medical procedure. We performed an online search for definitions for 'non-invasive', 'non-surgical', 'minimally invasive', 'minimal access', 'pinhole' and 'keyhole'. We then searched peer-reviewed medical papers (PRMPs) and patient facing websites (PFWs) for the following index procedures, to see which of the original 6 terms were used to describe them: transvaginal ultrasound, sclerotherapy for leg veins, botulinum toxin injections, dermal fillers, endovenous thermal ablation and laparoscopic gall bladder removal. We found a wide variety of definitions for each of the initial terms. In both PRMPs and PFWs, there were a variety of terms used for each index procedure (i.e.: transvaginal ultrasound, injections of sclerotherapy, botulinum toxin or dermal fillers being both 'non-invasive' and 'minimally invasive') showing confusion in the classification of procedures. We suggested the 'AI classification' based on access (A - none, B - natural orifice or C - penetrating an epithelial surface) and invasiveness (1 - none, 2 - surface damage, 3 - needle = <21G, 4 - cannula >21G but not a surgical trocar, 5 - surgical trocars or small incisions and 6 - incisions). The current confusion of terms used for procedures that are less invasive than the open surgical alternatives leads to confusion and possible false patient expectations. We have proposed an AI classification that can be applied easily to any procedure, giving a uniform classification for medical professionals and patients to understand.

Management of Gummy Smile Using Esthetic Crown Lengthening Technique

Abstract Excessive gingival display is a major concern for a large number of patients visiting the dentist. It is a multifactorial condition that needs to be managed in a sequential manner in order to reach proper treatment technique that targets and resolves the underlying etiologies. There are different etiologies of a gummy smile, such as vertical maxillary excess, short and hyperactive upper lip, altered passive eruption, anterior dentoalveolar extrusion, or a combination of these causes. Many techniques have been used to restore the dentogingival relation for the management of gummy smile. The various treatment modalities for Excessive Gingival Display includes gingivectomy, modified lip repositioning, orthognathic surgery, orthodontic therapy, hyaluronic acid infiltration, botulin toxin injections. This case report deals with the correction of Excessive Gingival Display using conventional gingivectomy.

The Morbid Impact of Environmental Toxins on the Human Nervous System: Dystonia Nexus with Organic Solvents, Pesticides, and Heavy Metals

Dystonia is a neurological disorder characterized by involuntary muscle contractions that lead to abnormal movements and postures. This review examines environmental toxins and their etiology and pathogenesis of dystonia. Environmental toxins – organic solvents, pesticides, and heavy metals – disrupt neural pathways and neurotransmitter functions, contributing to the development of dystonia. These toxins induce neurotoxicity through mechanisms involving oxidative stress, inflammatory responses, and interference with neurotransmitter synthesis and release. Organic solvents disrupt neuronal membrane integrity and neurotransmission, while pesticides impair neurotransmitter synthesis and receptor function. Heavy metals alter ion channel function, promote oxidative stress, and trigger inflammatory responses, causing neuronal damage. Diagnosing dystonia requires a thorough medical history, neurological examination, lab work, and specialized tests, including imaging and genetic testing. Treatment strategies focus on symptom management by identifying and eliminating the source of environmental toxin exposure and medications (e.g., dopaminergic agents, anticholinergics, GABAergic agents, and BOTOX injections). These strategies are complemented by physical therapy, nutritional support, regulating monitoring and follow-up, and education and counseling.