The Treatment of Facial Asymmetry with Botulinum Toxin: Current Concepts, Guidelines, and Future Trends

AbstractThis article will describe facial asymmetry secondary to facial nerve paralysis (FNP), and review current concepts, guidelines, and future trends. Despite the increasing use of botulinum toxin (BoNTA) in treating FNP, ideal dosage, timing, and additional therapies are not unequivocally established. Facial asymmetry significantly impacts quality of life (QOL) by strongly affecting self-perception and social interactions; injectables may mediate great clinical improvement. This article provides practical guidelines for the use of BoNTA and provides schemes for accurate assessment and documentation. A systematic, stepwise approach is recommended with methodical assessment, meticulous placement, conservative dosage, and careful follow-up. Future trends include the potential use of newly developed toxins, muscle modification with fillers, improved imaging techniques, and targeted QOL studies. Hopefully, a growing number of aesthetic injectors may become technically proficient and join multidisciplinary teams for managing FNP.

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Botulinum Toxin: A Treatment for Facial Asymmetry Caused by Facial Nerve Paralysis

Plastic & Reconstructive Surgery ◽

10.1097/01.prs.0000150149.74749.55 ◽

2005 ◽

Vol 115 (2) ◽

pp. 573-574 ◽

Cited By ~ 18

Author(s):

Richard P. Clark ◽

Craig E. Berris

Keyword(s):

Botulinum Toxin ◽

Facial Nerve ◽

Botulinum Toxin A ◽

Facial Asymmetry ◽

Facial Nerve Paralysis ◽

Toxin A ◽

Nerve Paralysis

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Nutritional Therapy In Ischemic Stroke Patients With Type 2 Diabetes Mellitus : A Case Report

Smart Medical Journal ◽

10.13057/smj.v3i1.42114 ◽

2020 ◽

Vol 3 (1) ◽

pp. 33

Author(s):

Cipuk Muhaswitri ◽

Diyah Eka Andayani ◽

Taufik Mesiano

Keyword(s):

Diabetes Mellitus ◽

Ischemic Stroke ◽

Blood Glucose ◽

Blood Glucose Level ◽

Glucose Level ◽

Nutritional Therapy ◽

Facial Nerve Paralysis ◽

Stroke Patients ◽

Nerve Paralysis

Introduction: The prevalence of stroke in Indonesia increased from 8.3 per 1000 population in 2007 to 12.1 per 1000 population in 2013, based on Riset Kesehatan Dasar (RISKESDAS) 2013. Diabetes mellitus (DM) is an independent risk factor and can be modified. Hyperglycemia that occurs in the acute phase of stroke is associated with an increase in mortality and poor clinical outcome after stroke. Moreover, stroke patients are at risk of developing hypoalbuminemia due to poor intake and the presence of a chronic inflammatory process. Methods: A 66-year-old female patient with third recurrent ischemic stroke, history of uncontrolled DM, conciousness based on GCS is E3M5Vaphasia, Nasogastric tube (NGT) was inserted and there was a right facial nerve paralysis and bilateral hemiparesis . Nutritional status of patient is obese-1. During follow up period, the patient's blood glucose level ranged from 194 g/dl-345 g/dl. Nutrition therapy is given with a target of 1350 kcal (32 kcal/kg). Its composition consists of 15% protein, 25% fat and 60% carbohydrate (preferred complex carbohydrates), in the form of DM-specific formula containing inulin and monounsaturated fatty acid (MUFA). This nutritional therapy was administrated six times per day via enteral pathway, followed by the administration of micronutrients of vitamins C, B and folic acid. Result: During follow up period, the patient tolerated well with the diet. After the 14 days hospitalization, there was improvement of blood glucose level (<200 g/dL). Albumin level increases from 2.5 g/dL to 2.9 g/dl by the nutritional therapy containing protein more than 1.2 g/kg/day. Conclusion: Administering a diet with the recommended composition and formula helps control hyperglycemia and improve hypoalbuminemia in patients that can improve the patient's clinical condition.

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No. 93 Botulinum Toxin Type A Injections in Severe Peripheral Facial Nerve Paralysis: 3 Case Reports

PM&R ◽

10.1016/j.pmrj.2014.08.225 ◽

2014 ◽

Vol 6 (8) ◽

pp. S114

Author(s):

Agustin Gutierrez Ruiz ◽

Leire Ortiz Fernandez ◽

M. Paz ◽

Abaitua Ezquerra ◽

Maite Pacheco Boiso

Keyword(s):

Botulinum Toxin ◽

Facial Nerve ◽

Case Reports ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Facial Nerve Paralysis ◽

Nerve Paralysis ◽

Peripheral Facial Nerve Paralysis

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Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up

Acta Endocrinologica ◽

10.1530/eje-11-0158 ◽

2011 ◽

Vol 165 (1) ◽

pp. 17-24 ◽

Cited By ~ 123

Author(s):

Hermann L Müller ◽

Ursel Gebhardt ◽

Carmen Teske ◽

Andreas Faldum ◽

Isabella Zwiener ◽

...

Keyword(s):

Negative Impact ◽

Prospective Trial ◽

Multivariable Analysis ◽

Multidisciplinary Teams ◽

Hypothalamic Obesity ◽

Surgical Strategies ◽

Hypothalamic Lesions ◽

Patient Load

BackgroundHypothalamic obesity has major impact on prognosis and quality of life (QoL) in childhood craniopharyngioma.Patients and methodsFor this study, 120 patients were prospectively recruited during 2001 and 2007 and evaluated after 3 years of follow-up (KRANIOPHARYNGEOM 2000). Body mass index (BMI) and QoL at diagnosis and 36 months after diagnosis were analysed based on the reference assessment of tumour localisation and post-surgical hypothalamic lesions. Treatment was analysed based on the neurosurgical strategy of 50 participating neurosurgical centres, the centre size based on the patient load.ResultsBMI SDS at diagnosis was similar in patients with or without hypothalamic involvement. Surgical lesions of anterior and posterior hypothalamic areas were associated with higher increase in BMI SDS during 36 months post-diagnosis compared with patients without or only anterior lesion (+1.8 BMISD, P=0.033, +2.1 BMISD; P=0.011), negative impact on QoL in patients with posterior hypothalamic lesions. Surgical strategies varied among the 50 neurosurgical centres (three large-sized, 24 middle-sized and 23 small-sized centres). Patients treated in small-sized centres presented with a higher rate of hypothalamic involvement compared with those treated in the middle- and large-sized centres. Treatment in large-sized centres was less radical, and the rates of complete resection and hypothalamic surgical lesions were lower in large-sized centres than those of the middle- and small-sized centres. However, a multivariable analysis showed that pre-operative hypothalamic involvement was the only independent risk factor for severe obesity (P=0.002).ConclusionsRadical neurosurgical strategies leading to posterior hypothalamic lesions are not recommended due to the potential to exacerbate hypothalamic obesity and impaired QoL. Treatment should be confined to experienced multidisciplinary teams.

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Neurotoxins

Facial Plastic Surgery ◽

10.1055/s-0039-1688844 ◽

2019 ◽

Vol 35 (03) ◽

pp. 230-238

Author(s):

Adrian A. Ong ◽

David A. Sherris

Keyword(s):

Botulinum Toxin ◽

Clinical Applications ◽

Facial Nerve Paralysis ◽

Hypertrophic Scars ◽

Nerve Paralysis ◽

Facial Plastic Surgery ◽

Off Label ◽

Brow Ptosis ◽

Facial Plastic ◽

The Aesthetic

AbstractBotulinum toxin is integral to the practice of facial plastic surgery. Since it was approved by the U.S. Food and Drug Administration for the temporary improvement of glabellar rhytids in 2002, botulinum toxin has achieved a growing number of off-label clinical applications. These include the management of facial rhytids, brow ptosis, excessive gingival display, masseteric hypertrophy, platysmal banding, facial nerve paralysis, hypertrophic scars, and keloids. Many forms of botulinum toxin have been developed, and their safety and efficacy have been thoroughly established. This article will review the aesthetic and functional uses of botulinum toxin as it relates to the field of facial plastic and reconstructive surgery. In addition, the authors will discuss the suggested quantity of units per injection site based on onabotulinumtoxinA.

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Management of facial paralysis following treatment of neurosurgical tumours

Romanian Neurosurgery ◽

10.33962/roneuro-2020-006 ◽

2019 ◽

pp. 41-45

Author(s):

Costan V. V. ◽

Ciofu M. L. ◽

Sava F. ◽

Boisteanu O. ◽

Dabija M.

Keyword(s):

Facial Paralysis ◽

Clinical Information ◽

Functional Results ◽

Facial Nerve Paralysis ◽

Intracranial Tumour ◽

Nerve Paralysis ◽

Neurosurgical Patients ◽

Gold Plate ◽

Suture Suspension

The purpose of this study is to present our experience on improving the quality of life of patients with facial paralysis due to an operated intracranial tumour, by performing minimally invasive static reanimation procedures. We reviewed the clinical information pertaining to neurosurgical patients with facial paralysis that underwent static reanimation. The study included 11 patients with complete facial nerve paralysis of all nerve branches, that reported different primary complaints upon presentation. The performed procedures consisted of gold plate insertion into the superior eyelid, inferior eyelid ectropion correction or suture suspension. The functional results were favourable in all cases and the resulting appearance was acceptable. The choice of the different techniques used is discussed. Good outcomes are possible using static reanimation with an adequate adaptation of the techniques to the main patient complaint.

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Efficacy of botulinum toxin for treating cramps in peripheral neuropathy

RRNMF Neuromuscular Journal ◽

10.17161/rrnmf.v2i3.14951 ◽

2021 ◽

Vol 2 (3) ◽

Author(s):

Tejas Mehta ◽

Richard Sommers ◽

Raghav Govindarajan

Keyword(s):

Botulinum Toxin ◽

Peripheral Neuropathy ◽

Pain Score ◽

Chart Review ◽

Botulinum Toxin A ◽

Retrospective Chart Review ◽

Wilcoxon Test ◽

Safe Procedure

Abstract Introduction: Muscle cramps are a common occurrence in patients with peripheral neuropathy and are known to cause significant distress and decrease the quality of life. Although several drug formulations have been used in the management of cramps, there is significant variability in terms of efficacy and tolerability in patients with peripheral neuropathy. This study aims to assess the efficacy of botulinum toxin A in the management of lower limb cramps in patients with peripheral neuropathy. Methods: This retrospective chart review included a total of ten patients with peripheral neuropathy with cramps. Relevant data such as age, gender, race, pain score and cause of peripheral neuropathy were documented. Statistical analyses to compare the variables was done using the Wilcoxon Test. The pain score before the administration, at 3-month, 6 month and 9 months follow up were compared. Results All patients enrolled in the study showed improvement of pain assessed by visual pain analog scale. An improvement of 1.60 (95%CI, p<0.05), 2.70 (95%CI, p<0.05) and 3.50 (95%CI, p=0.05) was noted between test scores from before administration of botulinum toxin to 3-month, 6 months and 9 months follow up with a range of 6, 4 and 4 respectively. Conclusion: Local BTX-A infiltration is a likely efficacious and safe procedure for improving pain associated with cramps in patients with peripheral neuropathy.

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Sequelae of Major Trauma Patients with Maxillofacial Fractures

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420958732 ◽

2020 ◽

pp. 000348942095873

Author(s):

Lasse Østrup Petersen ◽

Emil Ørskov Ipsen ◽

Ulrik Ascanius Felding ◽

Christian von Buchwald ◽

Jacob Steinmetz

Keyword(s):

Clinical Assessment ◽

Major Trauma ◽

Facial Nerve Paralysis ◽

Trauma Patients ◽

Initial Examination ◽

Nerve Paralysis ◽

Sensory Deficits ◽

Facial Contour ◽

Maxillofacial Fractures

Objectives: Sequelae after maxillofacial fractures are frequent and may affect the patient’s quality of life. This study examined sequelae associated with maxillofacial fractures of severely traumatized patients focusing mainly on nerve injuries. Methods: A retrospective study including trauma patients with relevant facial fractures admitted to our Trauma Center in the period 2011-2016. Presence of posttraumatic maxillofacial sequelae was identified by examining the medical records of the included patients. Focusing on facial sensory deficits and facial nerve paralysis, but also comprising data on diplopia, blindness, malocclusion, trismus, eye globe malposition, flattening of the malar, facial contour changes, and wound infections. Results: Two-hundred-seventy-five severely traumatized patients were included, comprising 201 men (73%), with a median age of 40 years and ISS of 20. 163 (59%) patients only had assessments within 3 months from trauma of which 79 patients (48.5%) had facial complications at initial examination, mostly malocclusion and trismus. Most patients in this group had no or only minor sequelae at their last clinical assessment, mainly being sensory deficits. 112 (41%) patients had assessments both within and beyond 3 months of which 73 patients (65.2%) had facial complications at initial examination, while 91 patients (81%) had reported sequelae within 3 months decreasing to 47 patients (42%) at their last clinical assessment beyond 3 months from trauma, mostly sensory deficits. An improvement of most sequelae was observed. Conclusion: Objective sequelae were found to be quite common after maxillofacial fractures in severely traumatized patients, especially sensory deficits. However, most of the addressed sequelae seemed to improve over time.

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