Application Of Toxin Research Articles

Botilinum toxin in the treatment of strabismus

Introduction: Strabismus is an oculomotor imbalance that occurs in 0.5 to 5% of the population. There are various etiopathogenetic theories and several modalities of treatment. One of these modalities is the application of botulinum toxin intramuscularly. This chemodenervation causes temporary muscle paresis which acts as a recession while its antagonist contracts. This achieves a temporary correction of strabismus. However, further research is needed. The aim of the paper was evaluation of published research studies on botulinum toxin as a treatment option in strabismus, as a primary and adjuvant therapy and as a preventive therapy in patients with abducens nerve palsy. For this purpose, we searched the major databases of the medical publications Medline and Pubmed, using keywords: strabismus, botulinum toxin. We found more than 50 articles related to our search for the last 30 years, 30 of which have been used for this review. In this review paper we have presented the most important insights from the literature, as well as our opinions and insights on the topic. Although further studies are needed regarding dosing as well as avoiding side effects, botulinum toxin has been shown to be a good alternative and adjunctive therapy to strabismus surgery, with the downside being that the effect is temporary. Positive effects and faster recovery have also been shown in patients with abducens nerve palsy.

The relationship between the use of orthotics and foot deformity in cerebral palsy

Aim: Foot deformities are seen in more than 50% of children with cerebral palsy (CP). These deformities may cause gait deviations and mobility disorders over time. We aimed to examine the relationship between orthosis use, gait disturbances, and foot deformities in patients with cerebral palsy. Here, we aimed to analyze the relationship between orthosis use and foot deformities. 
 Materials and Methods: The study was designed as cross-sectional, descriptive. One hundred and two patients who were admitted to Physical Medicine and Rehabilitation Health Care Committee were included. All patients were questioned about their age, birth history, maternal education level, orthosis use, surgery, and botulism toxin application. 
 Detailed neurological examination of all participants (including walking analysis and spasticity) was performed by the same experienced physiatrist.
 
 Results: A total of 102 patients (41 males/61 females; mean age 10.1 ± 6.8 years) were included in the study. The most common type of CP was spastic tetraparesis (37.3%). Most commonly, crouch gait was observed in 23.5% of the patients. 
 The rate of orthosis use in the lower extremity was 21.6%. The median duration of the use was 60 min/day, and the most frequent orthosis type was knee ankle foot orthosis (6.9%). Foot deformities were found in 84.3% of the patients (29.4%), and the most common foot deformity type was equinovarus. Also, 15.7% of the patients had botulism toxin application, and 9.8% had surgery. Foot deformity was observed less frequently in orthosis users (P= 0.042). Foot deformity was observed in 54.5% (n = 12) of the patients using orthosis. A negative correlation was found between spasticity score and ambulation (P= 0.00).
 
 Conclusion: Foot deformities were found high in non daily orthosis use group. With the widespread use of orthosis in children with CP, the development of foot deformities can be prevented.

GINGIVAL SMILE CORRECTION USING THE FLAPLESS TECHNIQUE

Introduction: The gummy smile is characterized by the extensive display of gingiva when smiling and ends up unfavoring the aesthetic aspect, generating dissatisfaction in many patients. This gingival disharmony has several etiologies and, taking into account that each individual presents their uniqueness, it is essential that the dentist knows the cause of each clinical situation, so that an effective, specific and respective treatment plan can be elaborated to the patient’s complaint. Objective: The present work aimed to present, through a case report, a gummy smile treatment using the “Flapless” technique. Case report: A 20-year-old female patient sought care in the undergraduate course in dentistry at the Centro Universitário da Serra Gaúcha – FSG, complaining of a gummy smile. The proposed treatment plan was a gingival surgery, using the “Flapless” technique, associated with the application of botulinum toxin, which would intensify the result of the gummy smile correction. However, after the surgical healing, the patient approved the result of the procedure and chose to end the treatment. Conclusion: Based on the clinical case presented, it was possible to conclude that gingival surgery through de Flapless technique was effective for the correction of the gingival smile, the patient obtained the desire result, without the need to associate other techniques to achieve the aesthetics of the smile.

Ethical Concerns in Dermatology and Cosmetic Applications

Our aim in this article is to consider ethical concerns and sensitivities in Dermatology and Cosmetic applications. It is appropriate for dermatologists to make cosmetic applications and use artificial intelligence aid as experts who know the structure and diseases of the skin best. The practice of cosmetology by physicians other than dermatologists creates ethical problems. Women are especially more interested in dermatology. Body dysmorphic disorders are more common in women. When dermatologists evaluate the cosmetic dermatology patient and create a treatment plan, if there are unrealistic expectations, the patient should be guided correctly by considering the patient's wishes. Social media applications, which have attracted attention in recent years, have caused an increase in body dysmorphic disorders in individuals. Cosmetology is a division that can never be separated from dermatology. Patients frequently apply to cosmetic dermatology because of hyperpigmentation problems, aging problems, hair problems, toxin applications, dermal filler procedures, chemical peels, and mesotherapy, and ablative laser procedures. Burns resulting from laser epilation applications performed in aesthetic centers, complications such as tissue necrosis caused by dermal filler procedures performed by non-physicians, cosmetic problems, soft tissue infections, and allergic reactions resulting from applications such as mesotherapy and platelet-rich plasma are diseases frequently seen in dermatology outpatient clinics. Another important issue is the materials used in platelet-rich plasma, mesotherapy, toxin application, and dermal filler applications must be in the Class 3 Medical device category. Patients who apply to clinics for treatment should be made aware of this issue and patients should be protected from the complications that these medications may cause. Physicians should not use products that do not have class 3 certificates in cosmetic dermatology to keep the cost of the product low, especially when choosing materials. In medicine, there is always an aesthetic concern beyond technical or even scientific concerns. We think that it is necessary to express and elaborate on the concerns arising from the ethical issues that are experienced or may be experienced in dermatology practices. Physicians always try to take the patient's psychological and pathological problems into consideration. However, ethical concerns should not be forgotten when treating the field of aesthetics.

Examples of Clinical Use of Botulinum Toxin: A Literature Review

Botulinum toxin (BoNT), being one of the most toxic substances known to mankind, due to its unique mechanism of action is used as an effective treatment for many diseases, including strabismus, blepharospasm, and hemifacial spasm. BoNT has received particular use as a long-acting analgesic due to its ability to inhibit the exocytosis of pain neuropeptides, including CGRP, Substance P, and modulate the expression of pain-related receptors as TRPV1, NMDA, AMPA, P2X3. Botulinum toxin injections are effective in the treatment of many pain conditions: diabetic neuropathy, chronic migraine, spinal cord injury. This article reviews the possibilities of clinical applications of botulinum toxin based on the analysis of articles in the PubMed database for specific search terms. The keywords “botulinum toxin”, “treatment”, “clinical use”, “pain reduction” were used to obtain references. The possibilities for the clinical use of botulinum toxin are growing every year. Currently, at least 8 commercially available preparations of botulinum toxin types A and B are known, the most recognizable of which are Botox, Dysport, and MyoBloc/NeuroBloc. Future research should focus on improving the safety profile and increasing the efficacy of botulinum toxin-based drugs. New types of botulinum toxin obtained through molecular reengineering will significantly increase its therapeutic efficacy.

The Evaluation of the Relationship between Changes in Masseter Muscle Thickness and Tooth Clenching Habits of Bruxism Patients Treated with Botulinum Toxin A.

Bruxism is defined as recurrent masticatory muscle activity. Although there is not an agreed treatment method for bruxism, the application of botulinum toxin A (BT-A) has become a reliable lately. This study aimed to evaluate the correlation between the changes in masseter muscle thickness and clenching habits in bruxism patients treated with BT-A. Twenty-five patients, 23 females and 2 males, diagnosed with possible sleep bruxism were included in the study. The Fonseca Anamnestic Index was applied to the patients to determine their clenching habits and depression levels both before the treatment, and 6 months after it. The masseter muscle thickness was measured using ultrasonography before the treatment and 3 months and 6 months after the treatment. All the patients were injected with a total of 50 U of BT-A, 25 U to each masseter. A statistically significant decrease in masseter muscle thickness was observed in the ultrasonography 3 and 6 months after the BT-A treatment. There was a statistically significant decrease in the Fonseca scores, in which the teeth clenching habits of the patients were evaluated 6 months after the treatment. Although there was a decrease in the depression levels of the patients 6 months after the treatment, this difference was not statistically significant. When the results of this study were evaluated, it was seen that the BT-A injections are an effective, safe, and side effect-free method in the treatment of bruxism and masseter hypertrophy.

Síndrome de arlequim idiopática: sucesso terapêutico com toxina botulínica

Harlequin syndrome is a rare autonomic disorder characterized by anhidrosis and lack of unilateral flushing of the face, which may affect the cervical and thoracic regions. Paradoxically, there is compensatory flushing and sweating on the contralateral side to the alteration. It is idiopathic in most cases, but it can be congenital or secondary to structural or post-surgical iatrogenic lesions. Treatment is directed at the causative factor. We describe the case of a patient with a diagnosis of idiopathic Harlequin Syndrome with botulinum toxin application in the hemiface affected by compensatory symptoms with good therapeutic respons

The effect of botulinum toxin application on latissimus dorsi and teres major muscles in patients with brachial plexus birth palsy: An electron microscopic and clinical study.

In brachial plexus birth palsy (BPBP), botulinum toxin may be utilized to prevent glenohumeral dysplasia and to maintain the stable growth of the glenohumeral joint. Repeated injections may cause muscular atrophy and their functional effects are uncertain. The aim of this study was to compare the microstructure and the function of the muscles that received two injections before transfer with the muscles that were not injected. BPBP patients that were operated between January 2013 and December 2015 were included in the study. Latissimus dorsi and teres major muscles were transferred to humerus in standard fashion. Patients were divided in two groups according to bo-tulinum toxin status. Group 1 was toxin negative whereas Group 2 was toxin positive. For each patient, mean latissimus dorsi myocyte thickness (LDMT) was measured with electron microscopy and pre-operative and post-operative active shoulder abduction, flexion, external and internal rotation, and Mallet scores were evaluated with goniometry. Fourteen patients (seven patients per group) were evaluated. Five patients were female whereas nine were male. Mean LDMT was not affected significantly (p>0.05). The operation improved shoulder abduction, flexion, and external rotation significantly (p<0.05), independent of the toxin status. The internal rotation decreased significantly only in Group 2 (p<0.05). The Mallet score increased in both groups, but it was not significant (p>0.05), independent of the toxin status. Botulinum toxin that was applied twice prevented glenohumeral dysplasia and it did not cause permanent latissimus dorsi muscle atropy and function loss in late period. It augmented upper extremity functions by alleviating internal rotation contracture.

Comparison of botulinum toxin applications in the treatment of obesity

Obesity is a global health problem, however, there is no consensus on the treatment for patients with a BMI between 30 and 35. Intragastric botulinum toxin injection (IGBT) has been proposed as a new endoscopic treatment for obesity, with the potential to delay gastric emptying and increase satiety by temporarily paralyzing the injected area. A retrospective study was conducted on 157 patients who received antral or fundus dominant IGBT and were followed up for 6 months with a diet program from January 2020 to December 2022. The patients were divided into three groups: Group 1 consisted of patients who received more injections in the fundus during IGBT, group 2 consisted of patients who received more injections in the antrum during IGBT, and group 3 consisted of patients who were only followed up with a diet program. Group 1 patients received 10 fundus and 10 antrum injections, while group 2 patients received 18 antrum and 2 fundus injections. Group 3 patients were only followed up with a diet program. Both antral and fundus dominant IGBT were effective in reducing body weight, and there was a significant difference between the two groups in terms of weight loss. Both groups 1 and 2 had significantly greater weight loss than group 3 (p&lt;0.001). Antral and fundus dominant IGBT can be considered as a potential treatment option for obese patients with a BMI between 30 and 35 who do not meet the criteria for bariatric surgery.

Application of botulinum toxin in the treatment of bruxism

Bruxism is a commonly reported functional para-function of the oral cavity. Its symptoms are quite characteristic and include, above all, excessive clenching and grinding of the teeth. (2) Other complaints most frequently reported by patients are headaches, pain in the temporomandibular joint, excessive tooth abrasion, damage to dentures, waking up at night, visual effect - the so-called "square jaw". The etiology is multifactorial therefore it is difficult to treat its symptoms.&#x0D; Botulinum toxin is a neurotoxin produced by the anaerobic bacteria Clostridium botulinum. Its mechanism is based on the reversible inhibition of acetylcholine release in neuromuscular junctions. Intramuscular injection of botulinum toxin is one of the treatments of bruxism. So far, this method is used off-label. Looking at the promising results of randomized studies on the use of botulinum toxin in bruxism, this may change in the near future. As shown by previous studies, it is not an ideal method, but nevertheless it is one of the most effective and the best for the patient. The downside to the use of botulinum toxin in the treatment of bruxism symptoms are, inter alia, contraindications to the use of this drug and the duration of its action - 3-6 months.&#x0D; This systematic review of selected articles and studies aims to examine the available literature in order to determine the effectiveness of the use of botulinum toxin in the treatment of bruxism and to assess whether it is currently the most effective method.&#x0D; Pubmed and Google Scholar were searched for literature.

Botulinum Toxin Treatment for Botulinum Toxin–Induced Blepharoptosis

Blepharoptosis, or eyelid ptosis, is one of the most common significant potential side effects of botulinum toxin (BTX) injection and is defined as drooping of the upper eyelid. Botulinum toxin injection to the pre-tarsal orbicularis oculi muscle for the correction of upper eyelid ptosis. We reviewed 2 patients with mild upper eyelid ptosis following BTX injection. The patients received pre-tarsal BTX injections via a transdermal approach. Signed consent was obtained from the patients for the publication of their case details and images. Ptosis was evaluated by measuring marginal reflex distance (MRD) values before and 2 weeks after treatment. The efficacy of the treatment was defined by improvement of more than 1 to 2 mm difference in MRD between the 2 eyes. The BTX injection is hypnotized to work by weakening the pre-tarsal orbicularis selectively, tending toward a balance of force favoring retraction. Botulinum toxin application to the pre-tarsal orbicularis was effective in raising the upper eyelid ptosis induced by BTX injection.

The clinical effect of botulinum toxin on pigmentation.

Botulinum toxin injection is a common cosmetic procedure often used to treat dynamic wrinkles, but it has also been observed to have a lightening effect on the skin. It is thought that this lightening effect develops due to muscle innervation blockage; however, the change in the amount of melanin levels has not been quantified. Thirty-one patients who presented to the dermatology clinic of a tertiary hospital for botulinum toxin injection for wrinkle treatment were included in the study. A standard dose of botulinum toxin was injected to each patient's forehead, glabellar, and crow's feet region, and then the melanin index (MI) was measured with the Mexameter® MX 18 (Courage + Khazaka Electronic, Köln). After botulinum toxin treatment, a statistically significant decrease was found in the forehead and upper face MI. The upper face total baseline MI was significantly lower in the Glogau 1 group than in the Glogau 2 group (P=0.033). The forehead 15th day MI was significantly lower in the Glogau 1 group than in the Glogau 2, 3, and 4 groups (P=0.030). Botulinum toxin application to healthy skin for wrinkle treatment can cause facial skin lightening by reducing MI. It was also remarkable that this decrease was more pronounced in the forehead, which is a region that is particularly vulnerable to sun exposure, compared to other regions. Younger people, who are included in the Glogau type 1 group, may benefit more from this lightening effect.

The growing importance of ultrasonography in cosmetic dermatology: An update after the 23rd IMCAS Annual World Congress (2022).

Ultrasound (US) has been used for many years in the field of medicine. Many specialties have embraced US as a quick, painless, and relatively inexpensive tool to assist the clinician in determining anatomy, pathology, and aid in diagnostic or therapeutic procedures. US allows for precise mapping of cutaneous and subcutaneous structures in the face, in particular vascular structures. The use of US leads to reduced chances of complications and clinical failures, rendering more safety and high quality. US is considered the first-imaging technique for dealing with fillers and managing their potential complications. US can be deployed for vascular mapping, safe placement of fillers, and directed low-dose hyaluronidase reversal of vascular adverse events. It is a noninvasive imaging modality that provides a good definition for studying the skin, deeper layers, and blood flow in real time. In other words, we go from static to dynamic anatomy. In addition, US can guide with the application of botulinum toxin, in order to define the muscular planes. US may contribute to a more personalized procedure, better cosmetic results, and help to avoid complications. In general, physicians tend to use it for prevention. Last, for research purposes, US examination provides valuable information on the behavior, longevity, and interaction of the filler within the tissues. This new approach for US-guided treatments is a very practical and an effective method in cosmetic dermatology. As doctors, we owe it to our patients to do our best to prevent any harm. We feel that in near future, US will be an essential diagnostic tool in any dermatology or cosmetic doctor's office to both ensure safety and provide legal protection for the professional.

8887 Hysteroscopic Intramyometrial Injection of Botulinum Toxin As Treatment for Chronic Pelvic PAIN of Uterine Origin

<h3>Study Objective</h3> to demonstrate the surgical technique of the intramyometrial application of botulinum toxin Hysteroscopic approach for the management of pelvic pain of uterine origin. <h3>Design</h3> A step-by-step description was made for the application of intramyometrial botulinum toxin via hysteroscopic. <h3>Setting</h3> Advanced gynecology laparoscopic and pelvic pain unit. <h3>Patients or Participants</h3> Patients with painful uterine syndrome who follows the diagnostic criteria: the presence of localized pain in the pelvis, colic or sensation of uterine contraction outside the cycle, dysmenorrhea, dyspareunia, physical examination findings of pain on uterine palpation as a uterine trigger. <h3>Interventions</h3> hysteroscopic Intramyometrial application of Botulinum Toxin for treatment of chronic pelvic pain of uterine origin. <h3>Measurements and Main Results</h3> Intramyometrial application of botulinum toxin under hysteroscopic guidance with general anesthesia, use of Bettochi's hysteroscope and surgical steel needle for cystoscopy (5 Fr, 30 cm) through the working channel, use of saline solution as a means of distention, vaginoscopy, entry into the endocervical canal and endometrial cavity, evaluation of the cavity, location of the ostium, injection of botulinum toxin type A dilution (200 IU in 20 cc SSN) application of 1 cc per point distributed on the anterior and posterior face of the uterine wall. <h3>Conclusion</h3> Hysteroscopic intramyometrial application of Botulinum toxin can be a treatment option in patients with chronic pelvic pain of uterine origin when conventional treatment fails. It is an easily reproducible procedure, with few side effects and effective in pain control in selected patients.

P-032 FASCIOTENS: FIRST CASE IN THE HOSPITAL OF MéRIDA

Abstract Aim Anterior abdominal wall incisional hernias are a problem present in approximately 11–20% of patients undergoing laparotomy. Incisional hernias with loss of right of abode are associated with many physical, physiological and psychological problems. In order to surgically repair these incisional hernias with loss of right of abode, we need to perform a prehabilitation of the incisional hernias. Effective prehabilitation is required in order to close the aponeurotic defect without tension and to return the hernial contents to the abdominal cavity. Material and methods A 59-year-old female patient with a history of open cholecystectomy and incisional hernia repaired on three occasions, presenting with multisaccular midline incisional hernia (M1-M4 W3) containing colon and greater omentum. Results After application of botulinum toxin and Fasciotens, it is possible to perform Rives-Stoppa retrorectus repair, being able to reduce the hernial content without tension and without increasing intra-abdominal pressure. Conclusions Prehabilitation in complex abdominal wall surgery is essential to repair large aponeurotic defects without tension. In addition, the application of Fasciotens after administration of botulinum toxin allows closure of the aponeurotic defect using standard abdominal wall closure techniques.

OC-072 SYSTEMATIC REVIEW AND META-ANALYSIS OF PREOPERATIVE ADMINISTRATION OF BOTULINUM TOXIN AS ADJUNCT TO VENTRAL HERNIA REPAIRS

Abstract Aim Preoperative application of botulinum toxin (BTX), with or without preoperative progressive pneumoperitoneum (PPP), is an adjunct to complex ventral hernia repairs, causing flaccid paralysis. We aim to evaluate the benefit of BTX in the advancement of the lateral musculature and decrease hernia defect width. Material &amp; Methods It was elaborated a systematic review and meta-analysis following PRISMA guidelines and registered at PROSPERO. “Ventral hernia”, “incisional hernia”, “abdominal wall” and “botulinum toxin” were searched. PubMed (Medline), EMBASE (OVID) and LILACS databases research. Results Five studies (235 patients) showed tha BTX significantly increases the lateral abdominal wall muscles length (4,07cm) (95%CI (3.65;4.49), p&amp;lt;0,1 I2=47%). Two studies (113 patients) showes that hernia defect width raised 1.24 cm (95%CI (-3.06;5.53), p&amp;lt;0,05, I2=76%) after BTX with or without PPP. Conclusions Increase in the volume of the abdominal cavity after BTX and PPP by enlargement of abdominal wall muscles may be related to improve outcomes such as decreasing abdominal compartiment syndrome and surgical site occurrences. Despite the Increase in the lateral abdominal wall after BTX, the decrease in hernia defect width was not obseved. Insted, meta-analysis showed a tendency of width increasing, taking into account considerable heterogeneity, witch may be related to PPP association. BTX in complex ventral hernias increases lateral abdominal muscles length and, thus, is suposed to decrease poor surgical outcomes, although the transverse diameter of the defect does not reduced as expected. Futher studies are necessary to evaluate benefits of BTX in complete fascial closure.

Botulinum toxin - an overview of applications in otorhinolaryngology

Background: Botulinum toxin (BT) is primarily known for its aesthetic applications, but there are many opportunities to use the toxin for the prevention and treatment of various other conditions. BT is not very widespread in otolaryngology practice, but can be effective in many diseases. The TB mechanism is related to the blockade of the muscular plate or the glandular one and is therefore effective in various muscular disorders and autonomic secretory disorders. Aim: The purpose of this work is to review the applications of botulinum toxin in otolaryngology. Material and methods: Scientific publications on the Pubmed platform were reviewed using the keywords: botulinum toxin and otolaryngology, and time descriptors were set for 20122022. Results: Botulinum toxin is an effective and safe treatment that causes minor and transient side effects, and its duration of action varies depending on the condition for which it is used (from 36 months on average, up to several years in Lucia Frey syndrome). This is the first-line treatment in Lucia Frey syndrome, laryngeal dystonia and synkinesis. The most common otorhinolaryngological indications, discussed in the following paper, in which botulinum toxin is one component of treatment include Lucia Frey syndrome, salivary fistulas, excessive salivation syndromes, laryngeal dystonia, vocal tremor, vocal granuloma, synkinesis in facial nerve palsy, dysphagia, and an interesting new indication for the use of the toxin in the treatment of resistant rhinitis. The following paper reviews the treatment protocols with botulinum toxin for the aforementioned indications and includes information such as management, dosage, injection sites. The study provides an introduction for ENTs interested in introducing botulinum toxin into their practice, as well as updates practical information for those already practicing. Conclusions: Botulinum toxin is a safe and effective treatment for a wide range of non-aesthetic indications in otorhinolaryngology.

Depletion of Foxp3+ regulatory T cells but not the absence of CD19+IL-10+ regulatory B cells hinders tumor growth in a para-orthotopic neuroblastoma mouse model.

Adaptive immune cells with regulatory function reportedly mediate immune escape in a variety of tumors. Little is known regarding the relevance of the most prominent regulatory cell populations, namely Foxp3+ T regulatory cells (Tregs) and CD19+IL-10+ B regulatory cells (Bregs), for neuroblastoma (NB) survival. After establishing a novel immunocompetent syngeneic NB mouse model where orthotopic tumors can be generated after intrarenal injection of NB975A cells, we studied the importance of Tregs and Bregs in Foxp3-DTR mice whose Tregs can be depleted by diphtheria toxin (DT) application as well as in CD19-specific IL-10 deficient mice that lack IL-10+ Bregs (CD19cre+/- × IL-10fl/fl mice). We observed Foxp3 Treg cells in tumors from wild type mice. On the contrary, Bregs or B cells were scarce. Specific depletion of Tregs in Foxp3-DTR mice resulted in an 85% reduction of tumor volume and weight compared to DT-treated wild type mice and untreated Foxp3-DTR mice. In contrast, NB tumor growth was not affected in CD19-specific IL-10 deficient mice. Similarly, mice lacking mature B cells (μMT mice) and CD19 deficient mice (CD19cre mice) showed no change in growth pattern of NB tumors. In Treg-depleted mice, reduced tumor growth was associated with an increased concentration of IFN-gamma, TNF-alpha, IL-4, IL-6, and IL-10 in isolated splenocytes. In summary, transient ablation of Tregs but not absence of Bregs hindered the growth of NB, strongly suggesting the therapeutic potential of targeting Tregs for this aggressive childhood tumor.

Histologic Evaluation of the Effects of Folinic Acid Chitosan Hydrogel and Botulinum Toxin A on Wound Repair of Cleft Lip Surgery in Rats.

The aim of the present study was to compare the effects of folinic acid chitosan hydrogel and botulinum toxin A on the wound repair of cleft lip surgery in rat animal models. Cleft lip defects were simulated by triangular incisions in the upper lip of 40 Wistar rats. Then, the rats were randomly assigned to four groups: control (CTRL), chitosan hydrogel (CHIT), and folinic acid chitosan hydrogel (FOLCHIT), in which the wounds were covered by a gauze pad soaked in normal saline, chitosan hydrogel, and folinic acid chitosan hydrogel, respectively for 5 min immediately after closure; and botulinum toxin A (BOT) with the injection of 3 units of botulinum toxin A in the wound region. Fibroblast proliferation, collagen deposition, inflammatory cell infiltration, neovascularization, and epithelial proliferation and each parameter were rated on days 14 and 28. Statistical analysis was performed by Kolmogorov-Smirnov test, Shapiro-Wilk test, Kruskal-Wallis, and post-hoc tests (α = 0.05). The mean score for fibroblast proliferation was significantly higher in the FOLCHIT group compared with the BOT group at days 14 and 28 (p < 0.001, p = 0.012, respectively). At day 28, collagen deposition was significantly higher in the FOLCHIT group compared with the BOT group (p = 0.012). No significant difference was observed between the inflammatory infiltration of the study groups at the two time points (p = 0.096 and p = 1.000, respectively). At day 14, vascular proliferation of group FOLCHIT was significantly higher than groups CTRL and CHIT (p = 0.001 and p = 0.006, respectively). The epithelial proliferation in the FOLCHIT group was significantly higher than groups CHIT and CTRL at day 14 (p = 0.006 and p = 0.001, respectively) and day 28 (p = 0.012). In simulated lip cleft defects, topical application of folinic acid induces faster initial regeneration by higher inflammation and cellular proliferation, at the expense of a higher tendency for scar formation by slightly higher fibroblast proliferation and collagen deposition. While injection of botulinum toxin A provides less fibroblast proliferation and collagen deposition, and thus lower potential for scar formation compared with the folinic acid group. Therefore, in wounds of the esthetic zone, such as cleft lip defects, the application of botulinum toxin A shows promising results.

SURGICAL TREATMENT FOR HYPERTROPHY OF BILATERAL MASSETER AND TEMPORAL MUSCLES: CASE REPORT

Hypertrophy of the masticatory muscles has an etiology not totally clarified and has been attributed to unilateral masticatory efforts due to tooth loss, temporomandibular joint disorders, or parafunctional habits. It usually affects young adults between the second and third decades of life. The objective of this research is to report a case of a 34-year-old male patient reporting an important bilateral increase in volume of the masseteric and temporal region associated with the myalgia of these muscles, the use of an occlusal splint for more than 5 years, and 2 previous applications of botulinum toxin with few improvements. The treatment option was surgical treatment with partial resection of the hypertrophied muscles, the masseter muscle through intraoral access, and the temporal muscle through bicoronal access. The patient has been undergoing clinical follow-up for 1 year, with improvement in both aesthetics and painful symptoms, with no signs of recurrence.