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BACKGROUND: The purpose of this study was to evaluate the clinical outcomes of treatment of non-odontogenic atypical orofacial pain using botulinum toxin-A. METHODS: This study involved seven patients (seven females, mean age 65.1 years) who had non-odontogenic orofacial pain (neuropathic pain and atypical orofacial pain) and visited the Seoul National University Bundang Hospital between 2015 and 2017. All medication therapies were preceded by botulinum toxin-A injections, followed by injections in the insignificant effects of medication therapies. Five of the seven patients received intraoral injections in the gingival vestibule or mucosa, while the remaining two received extraoral injections in the masseter and temporal muscle areas. RESULTS: In five of the seven patients, pain after botulinum toxin-A injection was significantly reduced. Most of the patients who underwent surgery for dental implantation or facial nerve reconstruction recovered after injections. However, the pain did not disappear in two patients who reported experiencing persistent pain without any cause. CONCLUSIONS: The use of botulinum toxin-A for the treatment of non-odontogenic neuropathic orofacial pain is clinically useful. It is more effective to administer botulinum toxin-A in combination with other medications and physical therapy to improve pain. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40902-018-0159-z) contains supplementary material, which is available to authorized users.
Subject(s)
Female , Humans , Botulinum Toxins , Dental Implantation , Dental Implants , Facial Nerve , Facial Pain , Mucous Membrane , Retrospective Studies , Seoul , Temporal MuscleABSTRACT
Objective To assess the efficacy and adverse reactions of two cconcentrations of diluted botulinum toxin A for dynamic frontotransverse wrinkles.Methods Totally 103 cases met the inclusion criteria were assigned into two groups by a random number table:high concentration group (50 U/ml,53 cases) and low concentration group (25 U/ml,50 cases).The two groups were given the local injection with 50 U/ml and 25 U/ml concentration of botulinum toxin type A,respectively.Dosage of BTX-A,the treatment effect,the duration of the effect and the incidence of adverse reactions were analyzed.Results The high concentration group were given the BTX-A (45.53±2.05) U,the low concentration group were given the BTX-A (25.71 ± 1.74) U,and the difference were statistically significant (P＜0.05).The differences of post-operative evaluation,time of onset and duration between the two groups were not statistically significant (P＞0.05).In the high concentration group,30 cases (88.24％) had forehead heaviness sensation,and 2 cases (5.71％) in the low concentration group,the difference were statistically significant (P＜0.01).Neither of the groups was given any specific treatment,the symptoms were disappeared in two weeks.In either group there was no serious complications such as intoxication,allergy,etc.Conclusions The efficacy of local injection with two concentrations of diluted botulinum toxin A in the treatment of dynamic frontotransverse wrinkles is positive,the duration of treatment effect between the two groups is similar,and therefore the 25 U/ml concentration is recommended to reduce the forehead heaviness sensation.
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Objective To evaluate the validity of botulinum toxin type A (BTXA) injections for the treatment of scar contracture.Methods 26 patients with scar contracture were randomly assigned into BTXA group and triamcinolone acetonide (TAC) group.Pinpoint tattooing was performed on each side of each scar in the plane of its longest axis.A template was used to ensure consistent length.These two tattoo points were measured to assess scar contraction at baseline,at every month for a total of 6 months.Histological analysis was conducted to study the physiological environment and immunohistochemistry to detect the expression of α-SMA and myosin-Ⅱ at different groups.Results Scar contraction was more relaxed in BTXA group than that in TAC group after 1 month (P＜0.05),especially in the 6th month (the D value in BTXA group and TAC group was (1.23±0.42) cm,and (0.56±0.33) cm respectively).For immunohistochemistry,the expression of α-SMA and myosin-Ⅱ also decreased in BTXA group (P＜0.05).Conclusions The treatment of scar contracture by suitable BTXA injections is safe and effective.
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Objective To evaluate the long-term effectiveness of different-dose of botulinum toxin A (BTXA) therapy on axillary hyperhidrosis.Methods Total 86 patients with axillary hyperhidrosis were self-controlled.One group of left axillary was injected with a low-dose of BTXA,50U.Another group of right axillary was injected with a high-dose of BTXA.A total dose of 200 U of BTXA was used per axilla.Patients were followed-up for 29 months.To investigate the effect of two methods,we analyzed two ranked data by rank sum test and x2 test to judge the disparities of the therapeutic effect.Results The results showed that the relapse-free interval of two groups with axillary hyperhidrosis was significant difference through the statistical analysis (P ＜ 0.05).Conclusions High-dose of BTXA treatment is capable of prolonging the antihidrotic effect on axillary hyperhidrosis.
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Objective To explore the therapeutic effect of infrabrow excision blepharoplasty combined with botulinum toxin A (BTXA) injection on periorbital rejuvenation.Methods A total of 146 females were involved in this study.The incision was designed,hiding at the lower edge of the brow.Eye orbicularis was folded,eyelid lift and some of the skin removed during operation,and simultaneously the shape of eyebrow was better adjusted.After suture cutting,BTXA was injected at the glabella and the lateral of canthus.Results All the 146 cases were followed up for 3 to 12 months.The blepharotosis symptom was improved effectively,the periocular wrinkles were alleviated obviously and no complications occurred in these patients.Conclusions Combining Infrabrow excision blepharoplasty with BTXA injection in periocular treatment is safe,convenient and effective.It is a good clinical approach to make periorbital rejuvenation.
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Objective To evaluate the clinical efficacy and safety of long-term repeated treatment of facial wrinkles with application of botulinum toxin A (BTXA). Methods A total of 52 patients had received 8 injections in seven years with BTXA against facial wrinkles, including forehead wrinkles, fishtail lines, glabellas wrinkles, and nasal dorsum transverse wrinkles. Besides day 1 (baseline) and day for the next injection (end-point), follow-up visits were scheduled on 1 week, 1 month, and 3 months after every injection. The therapy effect and safety were evaluated. Results For all the patients, it began to take effect on day 3 or 4 after the treatment and best effect appeared on 1 month post-treatment. Patients' selfevaluation as grade 1 for the improvement of forehead wrinkles, fishtail lines, glabellas wrinkles and nasal dorsum transverse wrinkles, accounted for 100%, 97.1%, 99.8% and 99%, respectively. Correspondingly, cases as grade 2 accounted for 0, 2.9%, 0.2% and 1.0%. Grades 3 to 5 had not been reported. With the repetition of treatment, the efficiency increased. The average of effective duration was (7.8±1.1) months, which lasted longer with the injection times increased (r= 0.256, P= 0.02). Adverse reactions observed in the previous several injections, including ecchymosis, feeling of tightness, rigid expression and severer wrinkles near the injected site, which were mild and the incidence rate decreased after the following injections (r= 0.850, P= 0.01). Severe adverse effects, such as allergic reaction,headache, blepharoptosis and dysraphism of eyes had not happened in all the 52 patients. Conclusion Long-term repeated application of BTXA against facial wrinkles is safe and the efficacy is confirmed. The approach can be applied repeatedly to those who have indications and good tolerance.
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Objective To evaluate the effectiveness and safety of Botulinum toxin-A (BTX-A) injection into detrusor to treat neurogenic detrusor overactivity in patients with spinal cord injury (SCI).Methods A total of 78 patients with SCI were treated with transurethral injection of BTX-A (300 IU dissolved in 15 ml of saline) into 30 different points of detrusor with 15 ml in every patients. Urodynamic parameters and voiding diary were assessed at baseline and 3 weeks and 3 months after the injections. Adverse events were recorded after the injection if present.Results After the first injection, 78 patients showed that the mean frequencies of incontinence decreased from 13.5 to 2.7 times per day, the mean volume of intermittent catheterization (IC) increased from 131 ml to 389 ml per time, the mean volume of incontinence decreased from 1 690 ml to 281 ml per day, the mean getting effect time was 7.6 days. 10 patients received second injection at 8.9 months after first injection, the results showed that the mean frequencies of incontinence decreased from 9.7 to 3.7 times per day, the mean IC volume increased from 108 ml to 387 ml. 6 patients received third injection at 5.8 months after second injection, the results showed that the mean frequencies of incontinence decreased from 9.2 to 3.9 times per day, the mean IC volume increased from 116 ml to 364 ml. No side effects were observed during the follow-up.Conclusion BTX-A injection into detrusor to treat neurogenic detrusor overactivity in patients with SCI seems to be an effective, safe and miniinvasive solution.
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@#ObjectiveTo evaluate the efficacy of rehabilitation associated with local intramuscular injection of botulinum toxic A (BTX-A) on spastic cerebral palsy (CP).Methods60 children with spastic CP were divided into experimental group and control group with 30 cases in each group. Cases of experimental group were treated with rehabilitation associated with local intramuscular injection of BTX-A. Cases of control group were treated only with rehabilitation treatment. The therapeutic efficacies of two groups were evaluated with physician rating scale (PRS) and activities of daily living (ADL) evaluation systems.ResultsImprovement of clinical evaluations index-PRS and ADL in experimental group was much more significant than that of control group (P<0.05). ConclusionRehabilitation associated with local intramuscular injection of BTX-A can improve the efficacy of spastic CP.
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@#ObjectiveTo investigate the optimal dose of botulinum toxic A (BTX-A) block to relax spasticity in cerebral palsy.Methods61 children (27～144 months old) with spastic cerebral palsy were treated by BTX-A block and divided into A, B, C, D and E groups according to the dose coefficient. The dose of BTX-A block was 30～160 IU (average 69.0±32.4 IU) according to the weight and the score of Modified Ashworth Scale.Results55 BTX-A blocks were successful. The muscles tone turned below and the function were improved. The effective rate was 90.16%. The effective time ranged from 8 weeks to 32 weeks, average 17.56±8.30 weeks. The effective time of the group C (2≤dose-coefficient<3) was the longest in the five groups.ConclusionThe optimal dose of BTX-A block in triceps surae should be counted as follow: dose(IU)=(score of Modified Ashworth Scale+2.5)×weight(kg).
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Objective To investigate the effect of Botulinum toxin type A(BTXA)and rehabilitation intervention on upper limb Brunnstrom stages and ADL performance of stroke patients. Methods In a randomized controlled trial, 30 patients were allocated to either an experimental group (n=15) that received BTXA injection into muscles of the affected arm or to a controlled group (n=15). All patients' Brunnstrom stage and MAS stage were ≥gradeⅡ. All the patients were treated with rehabilitative techniques. The intervention was applied for 3 months. All were evaluated for the severity of spasticity (Modified Ashworth Scale,MAS),the level of impairment (Brunnstrom assessment and Fugl-Meyer upper limb test) and disability(Functional Independence Measure,FIM) before and after 1 week, 1,2,3 months of treatment. Results Patients who received BTXA had significant reduction of muscle tone (P
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Objective To investigate the effect of B TX -A block by insulative needle to release the spasticity in cerebral palsy. MethodsFrom June 2000 to November 2002, 47 children wit h spastic cerebral palsy aged 2 to 15 years old, averaged( 6.32?2.52) years o ld were divided into an experiment group and a control group. The 33 children in the experiment group were blocked with BTX-A by insulative needles. The other 14 children in the control group were blocked with BTX-A by use of the convent ional syringe. ResultsThe spasticity in the experim ent group reduced to a larger extend than that in the control group, and the th erapeutic effect lasted longer in the experiment group. Conclusi onUsing insulative needle can improve the effect of BTX-A block.
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Objective To investigate the effect of local injection of Botulinum toxin type A(BTXA) on spasticity and function of the affected upper limb in stroke patients.Methods A total of 32 stroke patients were re- cruited and randomly divided into two groups:a BTXA group and a control group.All the patients had spasticity of upper limb muscles,which scored grade 2 to 3 with the Modified Ashworth Scale(MAS) ,and decreased elbow joint range of motion.The 16 patients in the BTXA group received BTXA injection in the biceps brachii muscles and flexor muscles of forearm on 10～15 points,while those in the control group did not.All the patients in both groups were treated with rehabilitation training techniques.The MAS,Fugl-Meyer upper limb function assessment and Barthel In- dex were employed to evaluate the changes of muscle tone,upper limb function and activity of living (ADL)perform- ance of the patients before injection and at 1st,2nd,6th 12th weeks after injection.Results The therapeutic effect between the BTXA group anti control group was significantly different in terms of biceps muscle tone,the scores of Fugl-Meyer upper limb function assessment and Barthel Index.Compared with preinjection,muscle tone was de- creased significantly and ADL performance was improved after injection in BTXA group.The effects of BTXA lasted more than 12 weeks.Conclusion Intramuscular muhipoint injection of BTXA was useful in reducing muscle spas- ticity,and was helpful for increasing motor ability of the affected upper limb and ADL performance of the stroke pa- tients.