scholarly journals Intramuscular Neural Distribution of Rhomboid Muscles: Evaluation for Botulinum Toxin Injection Using Modified Sihler’s Method

Toxins ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 289 ◽  
Author(s):  
Kyu-Ho Yi ◽  
Hyung-Jin Lee ◽  
You-Jin Choi ◽  
Ji-Hyun Lee ◽  
Kyung-Seok Hu ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Neurotoxin ◽  
Botulinum Toxin Injection ◽  
Entry Point ◽  
Middle Section ◽  
Essential Information ◽  
Spinous Processes ◽  
Intramuscular Nerve ◽  
Improved Performance ◽  
Botulinum Toxin Injections

This study describes the nerve entry point and intramuscular nerve branching of the rhomboid major and minor, providing essential information for improved performance of botulinum toxin injections and electromyography. A modified Sihler method was performed on the rhomboid major and minor muscles (10 specimens each). The nerve entry point and intramuscular arborization areas were identified in terms of the spinous processes and medial and lateral angles of the scapula. The nerve entry point for both the rhomboid major and minor was found in the middle muscular area between levels C7 and T1. The intramuscular neural distribution for the rhomboid minor had the largest arborization patterns in the medial and lateral sections between levels C7 and T1. The rhomboid major muscle had the largest arborization area in the middle section between levels T1 and T5. In conclusion, botulinum neurotoxin injection and electromyography should be administered in the medial and lateral sections of C7−T1 for the rhomboid minor and the middle section of T1−T7 for the rhomboid major. Injections in the middle section of C7−T1 should also be avoided to prevent mechanical injury to the nerve trunk. Clinicians can administer safe and effective treatments with botulinum toxin injections and other types of injections by following the methods in our study.

scholarly journals Treatment Efficacy of Electromyography versus Fiberscopy-Guided Botulinum Toxin Injection in Adductor Spasmodic Dysphonia Patients: A Prospective Comparative Study

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Jae Wook Kim ◽  
Jae Hong Park ◽  
Ki Nam Park ◽  
Seung Won Lee
Keyword(s):  
Botulinum Toxin ◽  
Treatment Efficacy ◽  
Botulinum Toxin Injection ◽  
Spasmodic Dysphonia ◽  
Total Dosage ◽  
Adductor Spasmodic Dysphonia ◽  
Prospective Comparative Study ◽  
The Mean ◽  
Botulinum Toxin Injections ◽  
The Voice

Introduction. This study prospectively evaluates and compares the treatment efficacy of botulinum toxin injection under electromyography guidance (EMG group) and percutaneous botulinum toxin injection under flexible fiberscopic guidance (fiberscopy group).Methods. Thirty patients with adductor spasmodic dysphonia (ADSD), who had never received treatment, were randomly allocated into EMG- or fiberscopy-guided botulinum toxin injections between March 2008 and February 2010. We assessed acoustic and aerodynamic voice parameters, and the voice handicap index (VHI) before injection and at 1, 3, and 6 months after injection.Results. The mean total dosage of botulinum toxin was similar for both groups: 1.7 ± 0.5 U for the EMG group and 1.8 ± 0.4 U for the fiberscopy group (P>0.05). There were no significant differences in outcomes between the two groups in either the duration of effectiveness or complications such as breathy voice and aspiration.Conclusion. Botulinum toxin injection under fiberscopic guidance is a viable alternative to EMG-guided botulinum toxin injection for the treatment of adductor spasmodic dysphonia when EMG equipment is unavailable.

Vocal Exercise versus Voice Rest following Botulinum Toxin Injections: A Randomized Crossover Trial

2010 ◽  
Vol 119 (11) ◽  
pp. 759-763
Author(s):  
Randal C. Paniello ◽  
Julia D. Edgar ◽  
Joel S. Perlmutter
Keyword(s):  
Botulinum Toxin ◽  
Primary Outcome ◽  
Botulinum Toxin Injection ◽  
Primary Outcome Measure ◽  
Adductor Spasmodic Dysphonia ◽  
Related Quality ◽  
Botulinum Toxin Injections ◽  
The Voice ◽  
Dose Injection

Objectives: The intensity of muscle activity immediately following intramuscular botulinum toxin injection may affect the clinical efficacy of the injection. We tested this effect in patients who underwent botulinum toxin injections for adductor spasmodic dysphonia. Methods: Patients were studied over 3 to 5 injection cycles. Cycle 1 was the baseline control; cycle 2 was randomized between a 1-hour reading aloud task (“exercise”) and a 24-hour period of complete voice rest. For cycle 3, the patient completed the task not performed in cycle 2. Patients who were willing to continue for cycles 4 and 5 repeated the experiment at one half the injection dosage. Efficacy was determined with a battery of voice recordings and clinical outcomes instruments administered via telephone at 2- to 4-week intervals. The primary outcome measure was the result of the Voice-Related Quality of Life (VRQOL) instrument. Results: Nine patients (8 women, 1 man) with a mean age of 60.8 years (range, 42 to 76 years) completed at least 3 injection cycles. The VRQOL results were significantly higher for cycles that followed the exercise task. The patients reported subjectively that these were some of the best injection cycles they had ever experienced. Some achieved equivalent results with the half-dose injection plus exercise. The VRQOL results after voice rest cycles were not significantly different from the patients' baseline cycles. Conclusions: These results support the conclusion that a period of intense vocalization immediately following laryngeal botulinum toxin injections improves the efficacy of the injection. Possible mechanisms are proposed.

Botulinum toxin injection for failed tracheo-oesophageal voice in laryngectomees: the Sunderland experience

2003 ◽  
Vol 117 (7) ◽  
pp. 544-548 ◽  
Author(s):  
K. Ramachandran ◽  
P. S. Arunachalam ◽  
Anne Hurren ◽  
R. L. Marsh ◽  
P. R. Samuel
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Neurotoxin ◽  
Speech Therapy ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Voice Restoration ◽  
Early Results ◽  
Pharyngeal Plexus

Spasm of the pharyngo-oesophageal segment is one of the important causes of tracheo-oesophageal voice failure. Traditionally it has been managed by either prolonged speech therapy, surgical pharyngeal myotomy or pharyngeal plexus neurectomy with varying degrees of success. Botulinum neurotoxin has been found to be effective in relieving pharyngo-oesophageal segment spasm. Since 1995, we have used botulinum toxin injection on 10 laryngectomees with either aphonia or hypertonicity due to pharyngo-oesophageal segment spasm. Early results were analysed by the Sunderland Surgical Voice Restoration Rating scale. Seven of the 10 patients, who were previously completely aphonic, developed voice following this therapy and are using their valve choice as their only method of communication. Out of the three patients who were treated for hypertonic voice, two did derive some benefit from the procedure. One patient developed a hypotonic voice, which lasted for a few months.

Transoral Electromyographic Recordings in Botulinum Toxin—Injected Rat Larynges

1997 ◽  
Vol 106 (11) ◽  
pp. 956-964 ◽  
Author(s):  
Katsuhide Inagi ◽  
Charles N. Ford ◽  
Arthur A. Rodriquez ◽  
Dennis M. Heisey
Keyword(s):  
Botulinum Toxin ◽  
Muscle Function ◽  
Vocal Fold ◽  
Human Subjects ◽  
Botulinum Toxin Injection ◽  
Objective Assessment ◽  
Spasmodic Dysphonia ◽  
Treatment Regimens ◽  
Botulinum Toxin Injections ◽  
Selection Of

Objective assessment of muscle function following botulinum toxin injections in laryngeal muscles is difficult in human subjects. We developed a rat laryngeal model for the study of botulinum toxin injection. A new laryngoscopic technique has made it possible to observe the rat larynx endoscopically and to obtain electromyographic measurements during and after injection of toxin. The electromyographic interference pattern, fibrillation potentials, and vocal fold movement were used for analyzing dose and volume effects of injected toxin. We conclude that the lowest dosage able to produce the maximal duration of functional laryngeal impairment is 0.07 U in a volume of 0.4 μL. This model will enable us to obtain physiologic and histologic parameters that can be used to assess the selection of optimal treatment regimens with botulinum toxin for the treatment of patients with spasmodic dysphonia.

Reduction of self-mutilating behavior and improved oromotor function in a patient with Lesch-Nyhan syndrome following botulinum toxin injection: A case report

2021 ◽  
Vol 14 (1) ◽  
pp. 133-136
Author(s):  
Courtney Gilbert ◽  
Michelle Sauer ◽  
JenFu Cheng
Keyword(s):  
Patient Safety ◽  
Case Report ◽  
Botulinum Toxin ◽  
Functional Status ◽  
Metabolic Disorder ◽  
Speech Therapy ◽  
Botulinum Toxin Injection ◽  
Optimal Dosing ◽  
Botulinum Toxin Injections ◽  
Masseter Muscles

Lesch-Nyhan syndrome is a genetic metabolic disorder often involving dystonia and self-mutilating behavior. This case report describes a 13-year-old boy with Lesch-Nyhan syndrome and self-mutilating behavior who received botulinum toxin injections to his bilateral masseter muscles after failing multiple other treatments. Following injections, the patient had reduction in self-biting, along with improvements in speech, mastication and feeding observed in speech therapy. Botulinum toxin injections to the masseters may help to improve oromotor function and reduce self-mutilating behaviors in children with Lesch-Nyhan syndrome who have failed more conservative treatments, providing opportunity for improved functional status and patient safety. Further investigation is indicated to establish optimal dosing. Additionally, the mechanism for the reduction of self-mutilating behavior is unclear and justifies additional investigation.

scholarly journals Physician Preferences for Botulinum Toxin Injections in Anticoagulated Patients with Spasticity

2016 ◽  
Vol 43 (4) ◽  
pp. 581-583 ◽  
Author(s):  
Adam Kassam ◽  
Chetan P. Phadke ◽  
Farooq Ismail ◽  
Chris Boulias
Keyword(s):  
Botulinum Toxin ◽  
Bleeding Complication ◽  
Botulinum Neurotoxin ◽  
Type A ◽  
International Normalized Ratio ◽  
High Variability ◽  
Complication Rates ◽  
Botulinum Neurotoxin Type A ◽  
Botulinum Toxin Injections ◽  
Anticoagulated Patients

AbstractTo understand physician preferences and bleeding complication rates of intramuscular botulinum neurotoxin type A injections for spasticity management in anticoagulated patients, questionnaires were mailed to 138 physicians across Canada. The international normalized ratio comfort range for injections was <2.0 in 10%, 2.0 to 2.5 in 35%, 2.6 to 3.0 in 25%, and 3.1 to 3.5 in 20% of physicians. Only 23% injected outside their comfort value and 57% did not; 72% did not normalize the international normalized ratio value before injections. Only one injector reported the development of compartment syndrome. As expected, high variability exists in physician preferences in botulinum neurotoxin type A injection in anticoagulated patients.

Adaptive Changes in Locomotor Activity Following Botulinum Toxin Injection in Ankle Extensor Muscles of Cats

2002 ◽  
Vol 87 (1) ◽  
pp. 229-239 ◽  
Author(s):  
J. E. Misiaszek ◽  
K. G. Pearson
Keyword(s):  
Botulinum Toxin ◽  
Ankle Joint ◽  
Neural Control ◽  
Motor Behavior ◽  
Botulinum Toxin Injection ◽  
Medial Gastrocnemius ◽  
Functional Deficits ◽  
Extensor Muscles ◽  
Botulinum Toxin Injections ◽  
The Impact

The present study investigated the adaptations made in motor behavior following a temporary reduction in ankle extensor activity in the walking cat. Temporary muscle weakness was induced by injecting botulinum toxin into the lateral gastrocnemius (LG), plantaris (PL), and soleus (SOL) muscles, or SOL alone. The medial gastrocnemius (MG) muscle was not injected. Adaptations in the level of muscle activity were recorded using chronically implanted electromyographic (EMG) electrodes. Serial recordings were made prior to botulinum toxin injections and for several days following the injections. Kinematic analysis of ankle joint movements was made from video records to assess the impact of the botulinum toxin injections on the function of the ankle joint during walking. Following injection of the LG, PL, and SOL muscles with botulinum toxin, the amplitude of the MG burst increased over a period of a few days to a week. This increase was similar to the previously reported changes produced in MG following transection of the nerves serving LG, PL, and SOL. Following the weakening of the ankle extensor muscles, there was a temporary deficit in ankle function during walking as evidenced by a marked increase in the amount of ankle flexion that occurred at stance onset. This functional deficit recovered relatively quickly and was not associated with a return of the EMG pattern to the preinjection pattern. After recovery from the initial injections, a second injection of botulinum toxin into SOL alone was performed. No functional deficits were observed in the ankle movements during walking following this second injection. However, weakening SOL produced increases in the burst amplitudes of the MG, LG, and PL muscles over a period of a few days. This suggests that normal movements at the ankle during walking can be generated with more than one pattern of ankle extensor activity and that there is flexibility in how the necessary torque is produced. A final procedure, transection of the nerves serving LG, PL, and SOL, failed to produce any functional deficits in ankle movements. The implication is that adaptations to the neural control of ankle extensor activity that were induced by the initial procedure persisted after the recovery of the injected muscles and were sufficient to compensate for the subsequent challenges.

scholarly journals Anatomo-sonographic identification of the longissimus capitis and splenius cervicis muscles: principles for possible application to ultrasound-guided botulinum toxin injections in cervical dystonia

2021 ◽  
Author(s):  
Eleonore Brumpt ◽  
Sebastien Aubry ◽  
Fabrice Vuillier ◽  
Laurent Tatu
Keyword(s):  
Botulinum Toxin ◽  
The Body ◽  
Mastoid Process ◽  
Ultrasound Guided ◽  
Fresh Cadaver ◽  
Levator Scapulae ◽  
Spinous Processes ◽  
Anatomical Correlation ◽  
Magnetic Resonance Imaging Mri ◽  
Botulinum Toxin Injections

Abstract Objective The main objective of this study was to define and verify anatomo-sonographic landmarks for ultrasound-guided injection of botulinum toxin into the longissimus capitis (LC) and splenius cervicis (SC) muscles. Methods and results After a preliminary work of anatomical description of the LC and SC muscles, we identified these muscles on two cadavers and then on a healthy volunteer using ultrasound and magnetic resonance imaging (MRI) to establish a radio-anatomical correlation. We defined an anatomo-sonographic landmark for the injection of each of these muscles. The correct positioning of vascular glue into the LC muscle and a metal clip into the SC muscle of a fresh cadaver as verified by dissection confirmed the utility of the selected landmarks. Discussion For the LC muscle, the intramuscular tendon of the cranial part of the muscle appears to be a reliable anatomical landmark. The ultrasound-guided injection can be performed within the cranial portion of the muscle, between the intra-muscular tendon and insertion into the mastoid process at dens of the axis level. For the SC muscle, the surface topographic landmarks of the spinous processes of the C4–C5 vertebrae and the muscle body of the levator scapulae muscle seem to be reliable landmarks. From these, the ultrasound-guided injection can be carried out laterally by transfixing the body of the levator scapulae. Conclusion The study defined two cervical anatomo-sonographic landmarks for injecting the LC and SC muscles.

Ethyl Chloride Spray for Sensory Relief for Botulinum Toxin Injections of the Hands and Feet

2009 ◽  
Vol 13 (5) ◽  
pp. 253-256 ◽  
Author(s):  
Robert N. Richards
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Ethyl Chloride ◽  
Special Equipment ◽  
Chloride Medium ◽  
Highly Effective ◽  
Hands And Feet ◽  
Botulinum Toxin Injections ◽  
Painful Injection ◽  
Injection Procedure

Background: Botulinum toxin injections are effective in the treatment of palmar and plantar hyperhidrosis, but discomfort has limited its use. Objective: To study the use of ethyl chloride medium-stream spray in reducing injection discomfort. Methods: We used ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, in our No Sweat Clinic for our most recent 51 consecutive cases of botulinum toxin injection. Results: Ethyl chloride spray greatly facilitated the injection procedure, and all patients completed the injections without hesitation or delay. Conclusion: Ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, is highly effective in reducing painful injection sensations. Its use is safe, economical, and easy to learn and does not require special equipment.

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