Botulinum Toxin Type A Treatment of Multiple Upper Facial Sites: Patient-Reported Outcomes

ABSTRACT Temporomandibular disorder (TMD) may be defined as a set of clinical scenarios involving the masticatory muscles, the temporomandibular joint (TMJ) and associated structures. Currently, 40 to 75% of the population has some sign of temporomandibular disorder, mainly pain located in the muscles of mastication in the pre-auricular region. The present clinical case was diagnosed as muscle temporomandibular disorder secondary to parafunction, as well as muscle hyperactivity due to surgical displacement of the left temporal muscle on two occasions, one for placement of aneurysm clips and the other for tumor excision from the supraorbital region on the left side. The patient sought medical and dental attention for 10 years due to constant headaches, tiredness and pain in the cheeks. The patient tried numerous bite-guards and pharmacological therapies to no avail. The American Academy of Orofacial Pain Questionnaire was applied combined with the Criteria for Research and Diagnostics (DRC) and a decision was made to use botulinum toxin type A in the masseter and temporalis muscles. An analog pain scale was applied over 90 days. Three days following the application of botulinum toxin type A, the patient reported a significant improvement with complete resolution of pain (level 0) after 90 days. At 12 weeks from starting treatment, facial muscle physiotherapy was introduced to strengthen the muscles of mastication and the patient remained pain-free, which allowed the preparation and adaptation of a snap-on prosthetic appliance. In conclusion, the use of botulinum toxin in patients with temporomandibular disorder should be considered as a viable therapeutic option.

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EFFECTIVENESS OF BOTULINUM TOXIN TYPE A IN CARPAL TUNNEL SYNDROME

Journal of Musculoskeletal Research ◽

10.1142/s0218957716500068 ◽

2016 ◽

Vol 19 (02) ◽

pp. 1650006 ◽

Cited By ~ 2

Author(s):

Francisco J. Juan-García ◽

Jacobo Formigo-Couceiro ◽

Manuela Barrio-Alonso ◽

Rubén Ouviña-Arribas

Keyword(s):

Botulinum Toxin ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Toxin A ◽

Surgical Methods ◽

Patient Reported ◽

Tunnel Syndrome

Background and objectives: Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it passes through the wrist. It can be treated with both surgical and non-surgical methods. Botulinum toxin type A has been used in the treatment of spasms, dystonia, migraine relief and myofascial pain. This study is aimed at evaluating the safety and tolerability of botulinum toxin type A in carpal tunnel syndrome. Methods: We conducted an open-label, prospective study using 30 units of onabotulinum Toxin A (Botox[Formula: see text]), injected into the carpal tunnel using the in-plane ultrasound-guided ulnar approach. We used the verbal numeric rating scale (VNRS) to assess changes in pain and paraesthesias both 4 and 12 weeks following the injection. All adverse effects were recorded. Results: A total of 18 patients with 22 mild-moderate idiopathic CTS were included in the study. A total of 14 women and 4 men with a mean of age [Formula: see text] years. Botulinum toxin A was well tolerated and only one patient reported temporary subjective weakness in his/her hand muscles. Both at 4 weeks and 3 months following the injection we observed a 63.6% subjective improvement in the patients’ level of pain and paraesthesias, with no statistical significance ([Formula: see text]). Conclusion: Our study shows the effects of botulinum toxin in relieving pain and paraesthesias in carpal tunnel syndrome with moderate symptoms. The use of an in-plane ultrasound approach for its injection into the carpal tunnel adds value and safety to the procedure, and, based on our experience, is well tolerated and safe. Further studies are required to confirm these results and define optimal doses of botulinum toxin.

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