Therapeutic Maneuvers Research Articles

Feasibility and safety of repositioning maneuvers for posterior semicircular canal BPPV (benign paroxysmal positional vertigo) in elderly over 80 years of age.

Balance problems in the elderly are a major social concern, primarily due to the risk of falls. One of the reasons of fast worsening of stability and therefore falling is represented by acute BPPV. Treatment through repositioning maneuvers could significantly reduce the risk of further falls of the patients treated with. The physical ability of older individuals to be treated with maneuvers is a topic of debate due to possible joint stiffness and less compliance with movements. There are few previous studies focusing on the practicality and effectiveness of physical therapy for BPPV in people over 80 years. We conducted a retrospective study collecting data on 517 patients to assess the feasibility, effectiveness, safety and the number of therapeutic maneuvers necessary to get therapeutic success when treating individuals over 80 years compared to those aged between 18 and 64. We found no difference in terms of number of maneuvers needed to get therapeutic success between the two groups. As for the therapeutic maneuver no difference in success and feasibility of execution was found between Semont and Epley maneuvers which proved equally effective in the two groups. Our data are not inconsistent with the hypothesis that repositioning maneuvers for posterior canal BPPV are feasible and demonstrated a good efficacy in all elderly people. This could encourage the diagnosis and treatment of BPPV also for the purpose of reducing the risk of falls in the elderly.

A 3D-Printed Educational Model for First-Line Management of BPPV in Emergency Departments.

We present a feasibility study on the development of a 3D-printed (3DP) model of benign paroxysmal positional vertigo (BPPV) and its validation as an educational tool for training in therapeutic maneuvers. A 1.5:1 3DP model of the human labyrinth, supplemented by a 1:1 3DP model of the skull, was obtained from a computed tomography scan. We presented the model to 15 Emergency Medicine residents, 15 medical students, 15 Otolaryngology residents, and 15 Otolaryngology practitioners from two academic referral centers. Participants performed the Semont and Epley maneuvers on the model twice, once before and once after observing the biomechanics of BPPV using this tool. A specific survey was then administered to assess both performance improvement and satisfaction. All the trainees demonstrated an improving trend on the second attempt. The medical students ameliorated significantly after the training in both Epley (p = 0.007) and Semont maneuvers (p = 0.0134). The Emergency Medicine residents improved significantly in Semont maneuvers (p = 0.0134). Self-reported understanding of the BPPV mechanics improved significantly after training in all the groups (p < 0.05). The preliminary data highlighted the potential benefits of training on the 3DP model for practitioners involved in the first-line management of BPPV.

Repositioning chair treatment procedure for cupulolithiasis: case report (with video)

IntroductionA cupulolithiasis of the lateral semicircular canal is an accumulation of otolithic debris at the level of the cupula of the same canal. Its pathophysiology generally generates a specific clinical presentation. This situation can be very disabling for the patient and tricky to treat for the clinician.Case reportThe patient was a 70-year-old man with cupulolithiasis of the right lateral semicircular canal. We present here the conversion of cupulolithiasis to canalolithiasis using the Thomas Richard Vitton (TRV) repositioning chair, as well as the treatment of this canalolithiasis through a mechanical liberation maneuver.ConclusionThe results of manual therapeutic maneuvers for Benign Paroxysmal Positional Vertigo (BPPV) are generally good regardless of the type of BPPV. It can sometimes be more challenging to resolve an ageotropic-type BPPV of the lateral semicircular canal and mechanically-assisted maneuvers using a repositioning chair may be required. Faced with symptom resistance despite attempts at multiple liberatory maneuvers, clinicians must be able to reconsider their initial diagnosis and investigate other potentially more serious origins of these symptoms. The TRV chair can be a treatment option in the management of cupulolithiasis, especially in cases where classic reduction maneuvers do not always yield good results.

Maternal outcomes of conservative management and cesarean hysterectomy for placenta accreta spectrum disorders: a systematic review and meta-analysis

BackgroundCesarean hysterectomy as a traditional therapeutic maneuver for placenta accreta spectrum (PAS) has been associated with serious morbidity, conservative management has been used in many institutions to treat women with PAS. This systematic review aims to compare maternal outcomes according to conservative management or cesarean hysterectomy in women with placenta accreta spectrum disorders.MethodsA systematic literature search was performed in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and four Chinese databases (Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Wanfang database and VIP database) to May 2024. Included studies were to be retrospective or prospective in design and compare and report relevant maternal outcomes according to conservative management (the placenta left partially or totally in situ) or cesarean hysterectomy in women with PAS. A risk ratio (RR) with 95% confidence interval (95% CI) was calculated for categorical outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. The Newcastle-Ottawa Quality Assessment Scale was used to assess the observational studies. All analyses were performed using STATA version 18.0.ResultsEight studies were included in the meta-analysis. Compared with cesarean hysterectomy, PAS women undergoing conservative management showed lower estimated blood loss [WMD − 1623.83; 95% CI: -2337.87, -909.79], required fewer units of packed red blood cells [WMD − 2.37; 95% CI: -3.70, -1.04] and units of fresh frozen plasma transfused [WMD − 0.40; 95% CI: -0.62, -0.19], needed a shorter mean operating time [WMD − 73.69; 95% CI: -90.52, -56.86], and presented decreased risks of bladder injury [RR 0.24; 95% CI: 0.11, 0.50], ICU admission [RR 0.24; 95% CI: 0.11, 0.52] and coagulopathy [RR 0.20; 95% CI: 0.06, 0.74], but increased risk for endometritis [RR 10.91; 95% CI: 1.36, 87.59] and readmission [RR 8.99; 95% CI: 4.00, 12.21]. The incidence of primary or delayed hysterectomy rate was 25% (95% CI: 19–32, I2 = 40.88%) and the use of uterine arterial embolization rate was 78% (95% CI: 65–87, I2 = 48.79%) in conservative management.ConclusionConservative management could be an effective alternative to cesarean hysterectomy when women with PAS desire to preserve the uterus and are informed about the limitations of conservative management.Prospero IDCRD42023484578.

Per-oral cholangioscopy in patients with primary sclerosing cholangitis: a 12-month follow-up study.

Background and study aims Patients with primary sclerosing cholangitis (PSC) have a 9% to 20% lifetime incidence of cholangiocarcinoma (CCA). Per-oral cholangioscopy (POCS) added to endoscopic retrograde cholangiography (ERC) could potentially improve detection of CCA occurrence. We prospectively assessed POCS identification of 12-month CCA incidence in PSC patients undergoing ERC. Patients and methods Consecutive patients with PSC, an indication for ERC, and no prior liver transplantation were enrolled. During the index procedure, POCS preceded planned therapeutic maneuvers. The primary endpoint was ability for POCS visualization with POCS-guided biopsy to identify CCA during 12-month follow-up. Secondary endpoints included ability of ERC/cytology to identify CCA, repeat ERC, liver transplantation, and serious adverse events (SAEs). Results Of 42 patients enrolled, 36 with successful cholangioscope advancement were analyzed. Patients had a mean age 43.5±15.6 years and 61% were male. Three patients diagnosed with CCA had POCS visualization impressions of benign/suspicious/suspicious, and respective POCS-guided biopsy findings of suspicious/positive/suspicious for malignancy at the index procedure. The three CCA cases had ERC visualization impressions of benign/benign/suspicious, and respective cytology findings of atypical/atypical/suspicious for malignancy. No additional patients were diagnosed with CCA during median 11.5-month follow-up. Twenty-three repeat ERCs (5 including POCS) were performed in 14 patients. Five patients had liver transplantation, one after CCA diagnosis and four after benign cytology at the index procedure. Three patients (7.1%) had post-ERC pancreatitis. No SAEs were POCS-related. Conclusions In PSC patients, POCS visualization/biopsy and ERC/cytology each identified three cases of CCA. Some patients had a repeat procedure and none experienced POCS-related SAEs.

The spatial orientation of crista ampullaris: implications for BPPV diagnosis and treatment.

This study aimed to provide a comprehensive understanding of the spatial orientation of the crista ampullaris within the inner ear and its implications for the diagnosis and management of benign paroxysmal positional vertigo (BPPV). Using high-resolution MRI scans of 55 normal inner ears, 3D models of the semicircular canals were segmented. These were complemented by detailed membrane labyrinth models from micro-CT scans of human temporal bones, accessed via the Comparative Ear Bank (www.earbank.org). A statistical shape model of inner ears and eyeballs was established, and a standardized 3D spatial coordinate system was created. The horizontal plane was defined using the top of the common crus and the bottom of the eyeballs. This calibrated reference system allowed for precise quantification of crista ampullaris orientations by calculating angles between the defined crista planes and coordinate planes. The plane of the ampulla and the corresponding semicircular canal plane are nearly perpendicular to each other. In the upright position, the posterior semicircular canal crista ampullaris formed an angle of 48.9° with the horizontal plane. The relative orientations of the crista ampullaris of the lateral and superior canals were also defined. Furthermore, we identified "zero-point planes" representing crista orientations perpendicular to gravity, which resulted in minimal ampullary stimulation. A 6.2° tilt to the left in the supine position resulted in the plane of the left lateral semicircular canal crista ampullaris being parallel to the direction of gravity. This study elucidates the precise spatial orientation of the crista ampullaris, thereby providing an anatomical basis for understanding BPPV pathophysiology and improving the accuracy of diagnostic and therapeutic maneuvers. The findings have the potential to significantly enhance the management of BPPV and other inner ear disorders.

Bowel preparation in children and adolescents undergoing ileo-colonoscopy: what is new?

Ileo-colonoscopy is a vital diagnostic and therapeutic tool undertaken for evaluating and treating gastrointestinal tract pathologies in children and adolescents as well as adults. Proper visualization of the lower intestinal mucosa, completion of the procedure including terminal ileum/cecal intubation, detection of pathological lesions and therapeutic maneuvers are hinged on how adequate the bowel preparation is. About 25% percent of pediatric patients have inadequate bowel preparations, which can lead to prolonged colonoscopy procedure time, missed pathology, difficult ileal intubation/incomplete examination, and requiring cancellation or repeat procedure with attendant anesthetic risks. An ideal bowel preparation regimen should clear the colon of fecal material with no alteration of the colonic mucosa that could affect the histological findings. There is no acceptable universal regimen for bowel preparation in children; however wide variability of practices exists globally. Hence, the current review is aimed at analyzing recent published literature and personal practical experiences as well as developing a standard bowel preparation guideline that will improve outcome of the ileo- colonoscopy procedure in children particularly in resource limited settings.

Substance P-Derived Extracellular-Matrix-Mimicking Peptide Hydrogel as a Cytocompatible Biomaterial Platform.

Self-assembled short peptide-based hydrogel platforms have become widely applicable biomedical therapeutic maneuvers for their soft, tunable architecture, which can influence cellular behavior and morphology to an inordinate extent. In this work, a short supramolecular hydrogelator peptide, substance P, has been designed and synthesized from the C terminus conserved "FFGLM" section of a biologically abundant neuropeptide by using a fusion approach. In addition, to incorporate a good hydrophobic-hydrophilic balance, the truncated pentapeptide segment was further C-terminally modified by the incorporation of an integrin-binding "RGD" motif. Thanks to its N-terminal Fmoc group, this octapeptide ensemble "FFGLMRGD" undergoes rapid self-assembly to give rise to an injectable, pH-responsive, hydrogel-based self-supporting platform that exhibited good cytocompatibility with the cultured mammalian cells under both 2D and 3D culture conditions without exerting any potent cytotoxic effect in a Live/Dead experiment. A rheological experiment demonstrated its hydrogel-like mechanical properties, including thixotropicity. The atomic force microscopy and field emission scanning electron microscopy images of the fabricated hydrogel show a tangled fibrous surface topography owing to the presence of the N-terminal Fmoc-FF residue. Furthermore, an in-vitro scratch assay performed on fibroblast cell lines confirmed the wound-ameliorating potency of this designed hydrogel; this substantiates its future therapeutic prospects.

The causes of adhesive direct dental restorations failures

The modern dental caries adhesive direct restoration requires a working protocol that includes stages and techniques that must be strictly followed to ensure the correct morphological and functional reconstruction, as well as an increased longevity of the restoration and implicitly of the respective tooth in the oral cavity. Failures in achieving these goals are represented by the occurrence of recurrent caries, secondary or residual caries, coronary fractures, leading to pulpal and periodontal complications. They can be due to both incorrect therapeutic maneuvers and other causes, for which the dentist is not responsible, such as manufacturing defects of dental materials that are not visible during inspection or the patient's attitude towards oral hygiene.

Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE‐3): Acute dizziness and vertigo in the emergency department

This third Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-3) from the Society for Academic Emergency Medicine is on the topic adult patients with acute dizziness and vertigo in the emergency department (ED). A multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding five questions for adult ED patients with acute dizziness of less than 2 weeks' duration. The intended population is adults presenting to the ED with acute dizziness or vertigo. The panel derived 15 evidence-based recommendations based on the timing and triggers of the dizziness but recognizes that alternative diagnostic approaches exist, such as the STANDING protocol and nystagmus examination in combination with gait unsteadiness or the presence of vascular risk factors. As an overarching recommendation, (1) emergency clinicians should receive training in bedside physical examination techniques for patients with the acute vestibular syndrome (AVS; HINTS) and the diagnostic and therapeutic maneuvers for benign paroxysmal positional vertigo (BPPV; Dix-Hallpike test and Epley maneuver). To help distinguish central from peripheral causes in patients with the AVS, we recommend: (2) use HINTS (for clinicians trained in its use) in patients with nystagmus, (3) use finger rub to further aid in excluding stroke in patients with nystagmus, (4) use severity of gait unsteadiness in patients without nystagmus, (5) do not use brain computed tomography (CT), (6) do not use routine magnetic resonance imaging (MRI) as a first-line test if a clinician trained in HINTS is available, and (7) use MRI as a confirmatory test in patients with central or equivocal HINTS examinations. In patients with the spontaneous episodic vestibular syndrome: (8) search for symptoms or signs of cerebral ischemia, (9) do not use CT, and (10) use CT angiography or MRI angiography if there is concern for transient ischemic attack. In patients with the triggered (positional) episodic vestibular syndrome, (11) use the Dix-Hallpike test to diagnose posterior canal BPPV (pc-BPPV), (12) do not use CT, and (13) do not use MRI routinely, unless atypical clinical features are present. In patients diagnosed with vestibular neuritis, (14) consider short-term steroids as a treatment option. In patients diagnosed with pc-BPPV, (15) treat with the Epley maneuver. It is clear that as of 2023, when applied in routine practice by emergency clinicians without special training, HINTS testing is inaccurate, partly due to use in the wrong patients and partly due to issues with its interpretation. Most emergency physicians have not received training in use of HINTS. As such, it is not standard of care, either in the legal sense of that term ("what the average physician would do in similar circumstances") or in the common parlance sense ("the standard action typically used by physicians in routine practice").

Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis

Horizontal Canal Cupulolithiasis (hc-BPPV-cu) can mimic a pathology of central origin, so a careful examination is essential to prevent misdiagnosis. Retrospective cross-sectional cohort study of 45 patients suffering from suspected hc-BPPV-cu. We recorded whether patients first presented through an ENT Emergency Department (ED) or through an Outpatient Otolaryngology Clinic (OC). We found statistically significant differences (p < 0.05) between the OC versus the ED in relation to the time between symptom onset and first assessment (79.7 vs. 3.6 days, respectively), the number of therapeutic maneuvers (one maneuver in 62.5% vs. 75.9%, and more than one in 25.1% vs. 13.7%), and multi-canal BPPV rate (43.8% vs. 3.4%). hc-BPPV-cu did not resolve in 2 patients (12.5%) from the OC and in 3 (10.3%) from de ED, all of which showed central pathology. There are no prior studies that analyze the approach to hc-BPPV-cu in the ED. The benefits of early specialist input are early identification of central positional nystagmus, a decrease in symptom duration, reduced number of therapeutic maneuvers required for symptom resolution, and lower rates of iatrogenic multi-canal BPPV. A comprehensive approach to hc-BPPV-cu in the ED allows both more effective treatment and early identification of central disorder mimics.

Treatment in Benign Paroxysmal Positional Vertigo: Factors that Affect Successful Treatment Outcome

Benign paroxysmal positional vertigo (BPPV) is the most common etiology of benign vestibulopathy. Various treatments for BPPV have been developed, and appropriate treatments for each subtype of BPPV have been provided and used in accordance with clinical practice guidelines published by the American Academy of Otorhinolaryngology-Head and Neck Surgery in 2008 and 2017. Although many therapeutic maneuvers have been reported to show high success rates in the treatment of BPPV patients, some cases are not effective even by appropriate therapeutic maneuvers. This article reviews various factors affecting the successful treatment of BPPV patients.

The supine hypotensive syndrome of pregnant women (SHSPW) diagnosis, therapy and prevention of complications in pregnant women (Review)

Drug-free therapy for prevention and treatment of supine hypotensive syndrome of pregnant women (SHSPW) is based on the application of the position of the pregnant woman on her back, partially modified by us: the patient is on her back, the table top is turned 15-20° to the left, only the head end of the operating table is raised by 40-45°, lower extremities in the knee joints are bent by 10-20° and up to 120° in the hip joints due to placing a roller in the popliteal area. This position of a pregnant woman is more natural for them, aimed at reducing the tension of the anterior abdominal wall, thus the uterus is slightly shifted forward and to the left, which contributes to the reduction of intra-abdominal pressure and pressure of the pregnant uterus on the terminal part of the aorta and iliac arteries and/or the distal part of the inferior vena cava and common iliac veins. And in addition, this position of the pregnant woman provides satisfactory access for the surgeon to the inguinal areas (external inguinal rings, both on the right and on the left), the perineum and along the entire length of the lower extremities for surgical interventions. In the literature, there are data on the effectiveness of the application of so-called «therapeutic maneuver» for the prevention and treatment of SHSPW in surgical practice.

STUDY OF DEMOGRAPHIC FEATURES, CLINICAL CHARACTERISTICS AND RISK FACTORS IN PATIENTS OF BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

Introduction BPPV is the most common peripheral vertiginous disorder in the community.Due to overlapping clinical features, this condition may be misdiagnosed and erroneously treated. Clear understanding of the demographic characteristics and clinical features may help in correct diagnosis and optimal management. Method 100 diagnosed patients of BPPV were prospectively studied. Parameters studied and analysed were:- age group and gender,affected ear and Semi circular canal(SCC), clinical features, various diagnostic and therapeutic manoeuvres, , associated comorbidities, treatment efficacy and recurrence rate. Results BPPV was most commonly seen in 4th decade with a significant female preponderence(M38/F62 ). Posterior-SCC (P-SCC) is most commonly involved(82%) followed by Horizontal-SCC (H-SCC)(17%) and Superior-SCC (S-SCC) (01%). Low serum vitamin-D3 was most commonly associated comorbidity(34%). 84% were primary BPPV while head trauma was the most common secondary cause . Remission rate on repositioning manoeuvre was 73%, recurrence rate 16% and failure rate was 11%. Conclusion Undiagnosed vertigo may significantly impacts the quality of life of a person. BPPV, in spite of being one of the commonest cause of vertigo is often misdiagnosed. If accurately diagnosed, BPPV repositioning manoeuvres have a high cure rate

ПОД МАСКОЙ ПЕРИФЕРИЧЕСКОГО ВЕСТИБУЛЯРНОГО СИНДРОМА

The article highlights the problem of differential diagnosis of peripheral vestibular syndrome, which hides such pathological processes as benign positional paroxysmal vertigo, vestibular neuronitis, Meniere's disease. The lack of specification in the diagnosis in this category of patients leads to erroneous diagnosis, inadequate treatment, an increase in the duration of disability and the occurrence of anxiety and depressive disorders. The article presents the differential diagnosis of peripheral vestibular syndrome, examples of therapeutic maneuvers and cases from practice. For effective diagnosis and treatment, it is necessary to take into account the clinical signs of the onset and manifestations of peripheral vestibular disorders, pay special attention to the questioning and detailed description of the patient's complaints, conduct special positional tests and consult with specialized specialists.

Primary sclerosing cholangitis-A long night's journey into day.

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Benign paroxysmal positional vertigo: diagnostic and therapeutic maneuvers

Benign paroxysmal positional vertigo (BPPV) is a very frequent cause of vertigo. BPPV occurs when there is a pathological presence of otolith debris in the semicircular canals. The history of BPPV is often typical, with recurrent episodes of vertigo lasting less than one minute, triggered by head movements, without other neurological signs. The characteristics of the nystagmus observed during the diagnostic maneuvers of Hallpike and Supine Head Roll test allow the identification of the affected semicircular canal and the choice of the appropriate therapeutic maneuver, which in most cases will lead to recovery. This article presents the diagnostic and therapeutic maneuvers.

Edema formation in congestive heart failure and the underlying mechanisms.

Congestive heart failure (HF) is a complex disease state characterized by impaired ventricular function and insufficient peripheral blood supply. The resultant reduced blood flow characterizing HF promotes activation of neurohormonal systems which leads to fluid retention, often exhibited as pulmonary congestion, peripheral edema, dyspnea, and fatigue. Despite intensive research, the exact mechanisms underlying edema formation in HF are poorly characterized. However, the unique relationship between the heart and the kidneys plays a central role in this phenomenon. Specifically, the interplay between the heart and the kidneys in HF involves multiple interdependent mechanisms, including hemodynamic alterations resulting in insufficient peripheral and renal perfusion which can lead to renal tubule hypoxia. Furthermore, HF is characterized by activation of neurohormonal factors including renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system (SNS), endothelin-1 (ET-1), and anti-diuretic hormone (ADH) due to reduced cardiac output (CO) and renal perfusion. Persistent activation of these systems results in deleterious effects on both the kidneys and the heart, including sodium and water retention, vasoconstriction, increased central venous pressure (CVP), which is associated with renal venous hypertension/congestion along with increased intra-abdominal pressure (IAP). The latter was shown to reduce renal blood flow (RBF), leading to a decline in the glomerular filtration rate (GFR). Besides the activation of the above-mentioned vasoconstrictor/anti-natriuretic neurohormonal systems, HF is associated with exceptionally elevated levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). However, the supremacy of the deleterious neurohormonal systems over the beneficial natriuretic peptides (NP) in HF is evident by persistent sodium and water retention and cardiac remodeling. Many mechanisms have been suggested to explain this phenomenon which seems to be multifactorial and play a major role in the development of renal hyporesponsiveness to NPs and cardiac remodeling. This review focuses on the mechanisms underlying the development of edema in HF with reduced ejection fraction and refers to the therapeutic maneuvers applied today to overcome abnormal salt/water balance characterizing HF.

MAP7D2 reduces CD8+ cytotoxic T lymphocyte infiltration through MYH9-HMGB1 axis in colorectal cancer

Immune checkpoint inhibitors (ICIs) represent a new paradigm in cancer immunotherapy, but can be largely restricted by the limited presence of CD8+ cytotoxic T lymphocytes (CTLs) in colorectal cancer (CRC) patients with microsatellite stable (MSS) tumors. Here, through next-generation sequencing, we identify microtubule-associated protein 7 domain 2 (MAP7D2) as an exploitable therapeutic maneuver to improve the efficacy of ICIs for MSS CRC therapy. In human CRC tissues, MAP7D2 expression is significantly increased in MSS CRC, and MAP7D2 adversely correlates with the presence of antitumor T lymphocytes. Invitro and in vivo experiments demonstrate that MAP7D2 knockdown significantly increases the infiltration of CD8+ CTLs, thereby inhibiting tumor progression and improving the efficacy of ICIs in MSS CRC murine models. Mechanistically, MAP7D2 interacts with MYH9 and protects it from ubiquitin-mediated degradation, subsequently decreasing the secretion of HMGB1, which suppresses the infiltration of CD8+ CTLs in MSS CRC. These findings highlight the importance of MAP7D2 in determining the infiltration of CD8+ CTLs and indicate that targeting MAP7D2 in MSS CRC may present a novel antitumor immunotherapy.

Assessment of intralesional injection of botulinum toxin type A in hypertrophic scars and keloids: Clinical and pathological study.

Keloids and hypertrophic scars are cosmetic problems with significant morbidity. Many clinical modalities were tried in order to modulate the disfigurement related to these pathologic scars. To evaluate the clinical and histopathological effects of Botulinum toxin type A (BTX-A) injection on keloids and hypertrophic scars. Twelve patients with keloids and 8 with hypertrophic scars were enrolled in this study. Botulinum toxin type A was injected intralesional (1 session/month) for three sessions. Clinical outcome was assessed via Vancouver Scar Scale (VSS), Observer Scar Assessment Scale (OSAS), and the Patient Scar Assessment Scale (PSAS). Histologic grading scores were used to assess the changes in the quality of collagen and elastic tissues and image analysis was used to detect their quantitative morphometric changes. This study showed a high statistically significant difference between baseline and the result after each of the three sessions of injection and 3, 6months after the last session regarding VSS, OSAS, and PSAS with p value ≤0.001 for each. The study also showed that there was a statistically significant difference between the histopathologic findings before injection of BTX and 1month after the third session regarding all parameters used. Botulinum toxin type A can be a good therapeutic maneuver for management of keloid and hypertrophic scars with significant clinical and histologic improvement.