Reanimação estática do lábio inferior na paralisia facial como complicação de preenchimento / Static lower lip reanimation as a filler complication of facial paralysis

Procedimentos de rejuvenescimento facial substitutos da cirurgia tradicional tornaram-se cada vez mais populares para promover uma aparência jovial com procedimentos minimamente invasivos, como toxina botulínica injetável, preenchimento de tecidos moles e peelings químicos. No entanto, complicações podem ocorrer mesmo na presença de um injetor habilidoso e experiente. Apresentamos o caso de uma paciente submetida a reanimação labial estática usando retalho dermoadiposo para lesão do nervo facial direito após remoção de nódulos como complicação de preenchimento. A "abordagem modificada de bull horn" foi realizada para elevação do lábio superior em torno das asas nasais e columela e ao longo do sulco nasolabial direito. O retalho foi desepitelizado e obtido. Usando a ponta aberta de uma pequena cânula de lipoaspiração, a porção distal do retalho foi encapsulada e fixada diretamente em C-loop e foram utilizados pontos U, transfixando o retalho para o periósteo do arco zigomático. Nos três anos de seguimento não foram observadas complicações significativas e a paciente não relatou nenhuma limitação funcional ou insatisfação com o aspecto das cicatrizes no sulco nasolabial e ao redor das asas nasais e da columela.

Facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular to promote a youthful appearance with minimally invasive procedures such as injectable botulinum toxin, soft-tissue fillers, and chemical peels. Nevertheless, complications can occur even with an astute and experienced injector. Here we present the case of a patient who underwent static lip reanimation using a dermoadiposal flap for right facial nerve damage following nodule removal as a filler complication. A "modified bulls horn approach" to the upper lip lift was performed around the nasal wings and columella and along the right nasolabial fold. The flap was de-epithelized and harvested. Using the open tip of a small liposuction cannula, the distal portion of the flap was tunneled and fixed directly in a C-loop fashion using U stitches, transfixing the flap to the periosteum of the zygomatic arch. At 3 years follow-up, no significant complications were observed, and the patient reported no functional limitations or dissatisfaction with the scars in the nasolabial fold or around the nasal wings and columella.

Toxina botulínica: compuestos emergentes en Chile / Botulinum toxin: compounds emerging in Chile

Botulinum toxin A is a vastly used therapy for treatment or management of a variety of health conditions. We are talking about a biological compound which is nowadays manufactured by many different laboratories, with distinct and specific characteristics for each one of their products. Although research and use of this toxin have been worldwide established for many years , in Chile we have been using it for over twenty years and since then its uses have been expanding to many fields. During the last few years, new toxins from different laboratories have been incorporated to our country, being necessary to know about them, their similarities and differences as well as to be aware of the uses that are approved or not for each particular drug. (AU)

Informe especial de brote: Brote intrafamiliar de botulismo alimentario / Outbreak special report: Intrafamily outbreak of food botulism

Presentación de dos casos notificados el 24 de diciembre de 2016 a la Gerencia Operativa de Epidemiología de la Ciudad de Buenos Aires por la Dirección de Epidemiología Nacional, sospechosos de botulismo alimentario en integrantes de una familia, e internados en efectores públicos y privados de la Ciudad de Buenos Aires. Se describen el cuadro clínico y el tratamiento recibido, la evolución de los pacientes, la patología de la enfermedad, y acciones de vigilancia epidemiológica: definición de casos sospechosos, de casos notificados, y notificación de la enfermedad. Incluye datos de instituciones de referencia en la Ciudad de Buenos Aires, para atención de esta patología

Architectural Changes of the Gastrocnemius Muscle after Botulinum Toxin Type A Injection in Children with Cerebral Palsy

PURPOSE: This study used ultrasonography (US) to investigate the architectural changes in gastrocnemius muscles (GCM) after botulinum toxin injection (BoNT-A) in children with cerebral palsy (CP). MATERIALS AND METHODS: Thirteen children with CP who received a BoNT-A injection into their GCM to treat equinus were recruited (9 males and 4 females). Architectural changes in both the medial and lateral heads of the GCM from a total of 20 legs were assessed using B-mode, real-time US. Muscle thickness (MT), fascicle length (FL), and fascicle angle (FA) were measured over the middle of the muscle belly in both a resting and neutral ankle position. Measures at 1 and 3 months after the injection were compared with baseline data taken before the injection. RESULTS: The mean age of the subjects was 5.8 (+/-1.6) years. Spasticity was significantly reduced when measured by both the modified Tardieu scale and the modified Ashworth scale at 1 and 3 months after injection (p<0.05). The MT and FA of both the medial and lateral heads of the GCM were significantly reduced for both neutral and resting ankle positions at 1 and 3 months after the injection. The FL of both the medial and lateral heads of the GCM were significantly increased in a resting position (p<0.05), but not in a neutral position. CONCLUSION: Our results demonstrated muscle architectural changes induced by BoNT-A injection. The functional significances of these changes were discussed.

Upper face rejuvenation using botulinum toxin and hyaluronic acid fillers.

The demand for facial rejuvenation is increasing, with each passing day, in all age groups. A number of procedures like chemical peels, microdermabrasion, laser and light therapies, and minimally invasive procedures like botulinum toxin injections (BTX A) and hyaluronic acid (HA) fillers are being extensively used by the dermatologist and plastic surgeons to meet this growing demand. A good knowledge of use of these techniques is becoming imperative for the dermatologist. In the present article, we discuss in detail the use of botulinum toxin injections and hyaluronic acid fillers for rejuvenation of upper face. Special emphasis has been placed on the complications associated with treatment of each area and on how to manage the same.

Estudo de pacientes com hiperidrose, tratados com toxina botulínica: análise retrospectiva de 10 anos / Study of patients with hyperhidrosis treated with botulinum toxin: a 10-year retrospective analysis

INTRODUÇÃO: A hiperidrose caracteriza-se por sudorese excessiva, isolada ou associada, da testa, das mãos, dos pés e das axilas. Atinge cerca de 1 por cento da população. O objetivo deste estudo foi observar os efeitos da toxina botulínica nos pacientes com hiperidrose, demonstrando a técnica, as áreas de incidência e a duração dos resultados obtidos. MÉTODO: Foi realizada análise retrospectiva de 39 pacientes com hiperidrose primária tratados no período de julho de 2000 a julho de 2010, acompanhados durante 12 meses. Desses pacientes, 36 por cento eram do sexo masculino e 64 por cento, do sexo feminino. A idade variou de 16 anos a 41 anos. No total, foram tratadas 135 áreas. Realizou-se tratamento com injeções intradérmicas de toxina botulínica. A dose total aplicada variou entre 37,5 U e 150 U, com dose média de 75 U para cada região tratada. RESULTADOS: O efeito terapêutico foi observado a partir do terceiro dia, com redução de 50 por cento dos sintomas na primeira semana do tratamento e de até 94 por cento do quadro de hiperidrose após a segunda semana de tratamento. A redução dos sintomas durou, em média, 7 meses. Nenhum caso de hiperidrose compensatória foi observado. A mortalidade foi nula. CONCLUSÕES: O tratamento da hiperidrose primária com toxina botulínica tipo A, embora temporário, é uma opção de tratamento eficaz, segura, pouco invasiva e com alto grau de satisfação, permitindo aos doentes o retorno às atividades profissionais no mesmo dia. Os efeitos colaterais e as complicações são temporários, pouco frequentes e regridem sem deixar sequelas.

BACKGROUND: Hyperhidrosis is characterized by excessive sweating of the forehead, hands, feet, and armpits, either alone or in combination. It affects about 1 percent of the population. This study aimed to observe the effects of botulinum toxin in patients with hyperhidrosis and demonstrates the application technique of botulinum toxin, the areas of incidence of the disease, and the duration of the results. METHODS: A retrospective analysis of 39 patients with primary hyperhidrosis treated between July 2000 and July 2010 and followed up for 12 months was carried out. Of these patients, 36 percent were male and 64 percent were female. Patient ages ranged from 16 to 41 years. A total of 135 areas were treated. Treatment consisted of intradermal injections of botulinum toxin. The total dose applied ranged from 37.5 U to 150 U, with an average dose of 75 U for each treated area. RESULTS: The therapeutic effect of botulinum toxin was observed from the third day after treatment, with a 50 percent reduction in symptoms within the first week of treatment and up to 94 percent reduction in the number of hyperhidrosis events after the second week. The reduction of symptoms lasted, on average, for 7 months. No cases of compensatory hyperhidrosis or mortality were observed. CONCLUSIONS: The treatment of primary hyperhidrosis with type A botulinum toxin, although temporary, is an effective, safe, and minimally invasive treatment option. It has a high degree of satisfaction and allows patients to return to their professional activities on the same day. Side effects and complications are temporary, infrequent, and regress without sequelae.

Noncosmetic periocular therapeutic applications of botulinum toxin

Botulinum toxin blocks acetylcholine release at the neuromuscular junction. The drug which was initially found to be useful in the treatment of strabismus has been extremely effective in the treatment of variety of conditions, both cosmetic and noncosmetic. Some of the noncosmetic uses of botulinum toxin applications include treatment of spastic facial dystonias, temporary treatment of idiopathic or thyroid dysfunction-induced upper eyelid retraction, suppression of undesired hyperlacrimation, induction of temporary ptosis by chemodenervation in facial paralysis, and correction of lower eyelid spastic entropion. Additional periocular uses include control of synchronic eyelid and extraocular muscle movements after aberrant regeneration of cranial nerve palsies. Cosmetic effects of botulinum toxin were discovered accidentally during treatments of facial dystonias. Some of the emerging nonperiocular application for the drug includes treatment of hyperhidrosis, migraine, tension-type headaches, and paralytic spasticity. Some of the undesired side effects of periocular applications of botulinum toxin inlcude ecchymosis, rash, hematoma, headache, flu-like symptoms, nausea, dizziness, loss of facial expression, lower eyelid laxity, dermatochalasis, ectropion, epiphora, eyebrow and eyelid ptosis, lagophthalmos, keratitis sicca, and diplopia

O uso da toxina botulínica na síndrome da bexiga hiperativa / The use of botulinum toxin in the treatment of overactive bladder syndrome

Nos últimos anos, a toxina botulínica (BTX) vem surgindo como uma opção para tratamento de algumas disfunções do trato urinário, como, por exemplo, a síndrome da bexiga hiperativa. Ela foi descrita pela primeira vez por Emile Pierre Marie van Ermengem em 1897 e desde então, vem se tornando uma importante arma terapêutica. Dos sete tipos distintos de BTX, somente os tipos A e B estão disponíveis para uso clínico. Seu mecanismo de ação consiste em causar paralisia flácida ao ser injetada no músculo, inibindo a ação da acetilcolina nas junções colinérgicas pré-sinápticas. Seu efeito é transitório e dose-dependente. A bexiga hiperativa é doença comum, que atinge cerca de 17% da população européia e norteamericana. Geralmente, ela é tratada de forma conservadora, principalmente com drogas antimuscarínicas, que são as drogas de escolha. Realizamos revisão da literatura, por meio do PubMed com o objetivo de verificar as indicações desta medicação, sua posologia, técnica de aplicação, efeitos colaterais, complicações e eficácia nas pacientes portadores de bexiga hiperativa neurogênica e idiopática. Foi concluído que a BTX parece ser uma opção de tratamento segura e eficaz para estas pacientes, porém mais estudos precisam ser realizados, principalmente para os portadores de bexiga hiperativa idiopática refratária aos tratamentos convencionais.

In the past few years, botulinum toxin (BTX) is being recognized as an option for the treatment of the urinary tract dysfunctions like overactive bladder syndrome. It was first isolated by Emile Pierre Marie van Ermengem in 1897 and, since then it is becoming an important treatment option. Of the seven distinct types of the toxin, only types A and B are available for clinical use. When injected into the muscle, the toxin acts by inhibiting acetylcholine release at the presynaptic cholinergic neuromuscular junction. Its effect is transient and dose-related. The overactive bladder is a commun disease that affects about 17% of the population in Europe and in the United States. Usually, the treatment is conservative and the mainstay is anticholinergic drugs. It was reviewed the literature using PubMed with the objective of verifying the indications, posology, technique of administration, side effects, complications and efficacy in patients with neurogenic and idiopathic overativity bladder. It was concluded that BTX seems to be a treatment option, which is safe and effective for these patients, but more studies are needed especially on the idiopathic overactive bladder.

Efeitos adversos associados à aplicação de toxina botulínica na face: revisão sistemática com meta-análise / Adverse effects associated with facial application of botulinum toxin: a systematic review with meta-analysis

OBJETIVO: Verificar a ocorrência dos efeitos adversos relacionados ao uso da toxina botulínica na face, por meio de revisão sistemática, usando meta-análise. MÉTODOS: Foi realizada pesquisa eletrônica de artigos publicados no MEDLINE e Cochrane Library até setembro de 2007. A ocorrência dos efeitos adversos foi verificada pela freqüência relativa para os relatos de casos e do risco relativo para os estudos randomizados. A heterogeneidade foi avaliada pelo teste Q e pelo índice I². Foi utilizado o teste de significância de Egger para identificar viés de publicação e a análise de sensibilidade para verificar o efeito dos viéses de publicação. RESULTADOS: Oito estudos randomizados e treze relatos de casos preencheram os critérios de inclusão. Na revisão sistemática dos relatos de casos, 1.003 pacientes foram estudados, dos quais 182 (18,14 por cento) apresentaram efeitos adversos. O efeito adverso mais freqüente foi a ptose palpebral ocorrendo em 34 (3,39 por cento) pacientes dos relatos de casos. Na meta-análise dos estudos randomizados, o risco relativo global para os efeitos adversos como cefaléia, ptose palpebral, reação local e infecção foi 1,07, 3,25, 0,99 e 0,94, respectivamente. Para todas as comparações, o valor de P foi maior que 0,05. CONCLUSÃO: O efeito adverso mais freqüente e que apresentou o maior risco relativo relacionado ao uso da toxina botulínica na face foi a ptose palpebral. A padronização dos efeitos adversos relatados é necessária a fim de melhor estabelecer as características dos mesmos.

PURPOSE: To estimate the occurrence of adverse effects associated with the use of botulinum toxin by performing a systematic review and meta-analysis. METHODS: A systematic literature search of MEDLINE and Cochrane Library was conducted until September 2007. The occurrence of the adverse effects was estimated of the relative frequency for case report and of the relative risk for randomized trials. Heterogeneity was evaluated with the Q test and I² index. Egger's significance test was used to identify the publication bias. Sensitivity analysis was performed to evaluate the effect of the publication biases. RESULTS: Eight randomized trials and thirteen case reports filled the inclusion criteria. In the systematic review of case reports, 1,003 subjects were studied and 182 (18.14 percent) showed adverse effects. Eyelid ptosis was the most frequent adverse effect, presenting in 34 (3.39 percent) patients of the case reports. In the meta-analysis of randomized trials, the overall relative risk for adverse effects as headache, eyelid ptosis, local reaction and infection was respectively: 1.07, 3.25, 0.99 and 0.94. For all comparisons, P values were greater than 0.05. CONCLUSION: Ptosis was the most frequent adverse effect and showed the higher relative risk associated with botulinum toxin. It is necessary to perform a pattern of adverse effects related for better understanding the relationship between adverse effects and use of botulinum toxin.

Botulinum toxin injection in the treatment of upper eye lid retraction in thyroid ophthalmopathy

The aim of this study to evaluate the effects and safely of inducing a temporary partial ptosis of the eyelid through injection of botulinum toxin into the levator palpebrae superioris muscle. Eight cases with persistent lid traction with normal thyroid function and refused to be surgically corrected. Botulinum toxin a [BOTOX] was injected into the levator palpebrae superioris muscle after administration of topical anesthesia and the patient were followed up for one year. They were followed up with routine ophthalmic examination and measuring the degree of ptosis. All patients experienced relief of discomfort and appearance, ptosis induced in all cases to a variable degree. One week after the injection 2 patients [25%] experienced diplopia which was transient. All patients did not experience change in the degree of exophthalmos or tissue edema. BOTOX injection in the management of upper eyelid retraction is a safe technique simple and could be used in cases of contraindication of surgical intervention in cases of thyroid associated ophthalmopathy

Experiencia con toxina botulínica en el tratamiento de la disfonia espasmódica / Experience with botulinic toxine in the treatment of spasmodic dysphonia

Disfonía espasmódica o distonía laríngea son los términos clínicos utilizados para referirse a una alteración neurológica central, de carácter crónico y progresivo. Históricamente estos enfermos han sido tratados por numerosos especialistas, sin resultados satisfactorios. Respecto al manejo otorrinolaringológico se ha intentado múltiples tratamientos, incluyendo la sección del nervio recurrente laríngeo, técnicas fonoquirúrgicas y el uso de fármacos, todos ellos con numerosos efectos adversos y malos resultados vocales. La terapia de elección, desde 1984, es la infiltración de toxina botulínica en la musculatura laríngea intrínseca distónica. El presente trabajo muestra la experiencia clínica con la inyección de toxina botulínica en 20 pacientes con distonía laríngea, realizada en el Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile. Quince de ellos fueron infiltrados con esta toxina. Los restantes 5 pacientes no se inyectaron porque rechazaron este tratamiento. Se comparan los resultados vocales en ambos grupos, utilizando la escala de ranking vocal abreviada (Blitzer y cols., 1992), concluyéndose que los pacientes infriltrados mejoraron su voz; en cambio, quienes no se infiltraron permanecieron o progresaron en su compromiso vocal.

Perspectivas de la terapia con toxina botulínica en distonia / Botulinum Toxin therapy for dystonia: a view

A dos décadas de la aparición de las primeras publicaciones sobre los usos terapéuticos de la toxina botulínica (TB), presentamos una revisión sobre la situación de esta terapia en pacientes con distonía, analizando efectividad, seguridad y complicaciones. Se comentan aspectos en controversia tales como: valor de la determinación de anticuerpos, correlación de éstos con la respuesta clínica y homologación de las unidades de TB, para las formulaciones de tipos A y B, disponibles en el mercado.

Botulinum toxin: a dreaded toxin for use in human being.

Botulinum toxin is a dreaded biological toxin elaborated by Clostridium botulinum. The action of this toxin is to cause paralysis of both voluntary and involuntary muscles. The unique property of paralysing capability of muscles has been used for the benefit of human beings. Dr Allan Scot, an ophthalmologist, first used the toxin in a patient with squint in 1981 and since then the botulinum toxin is being used in various disorders characterised by muscle overactivity such as spasticity in both children and adult, dystonic conditions such as blepharospasm, cervical dystonia, spasmodic dysphonia, writer's cramp, etc, hemifacial spasm and headache. Its main action is at the terminal nerve endings of myoneural junction and it prevents release of acetylcholine from vesicles thus causing chemical denervation. Its action persists for 3 to 4 months on an average. Its side effects such as drooping, diplopia, dysphagia, depending on the sites of injection, are few and usually transient. Generalised anaphylaxis is almost unknown. Now botulinum toxin is being used in non-neurological conditions where muscles are under spasmodic state such as achalasia cardia, anal fissure, spasm of urethral sphincter, etc. Because of wider safety range and fewer complications, botulinum toxin has been an important therapeutic armamentarium in different branches of medicine and surgery.

El uso de la toxina botulínica en otorrinolaringología / Use of botulinic toxin in otorrhinolaryngology

Los autores revisan la literatura relacionada con el uso de la toxina botulínica, haciendo especial hincapié en las conclusiones del Consenso del Instituto Nacional de Salud de los Estados Unidos. Posteriormente se describen las indicaciones del uso de la toxina en las alteraciones de la voz y del espasmo del músculo cricofaríngeo, así como la técnica de inyección de la misma. Finalmente se analizan los resultados obtenidos en dos series de pacientes, describiendo los hallazgos, las dosis usadas y los efectos laterales observados

Inyección intramuscular de toxina botulínica con fines dermocosmiátricos / Intramuscular injection of botulin toxin for dermocosmetic use

La toxina botulínica producida por el Clostridium botulinum es un potente inhibidor neuromuscular local, altamente específico, que actúa mediante bloqueo de la liberación de acetilcolina en la placa neuromuscular, traduciéndose clínicamente en una parálisis fláccida del músculo tratado. El uso de la toxina botulínica se ha visto incrementado en los últimos años, tanto en clínica como en ciencias básicas, existiendo numerosos estudios que avalan su utilización con fines terapéuticos y de investigación. El propósito de esta revisión es analizar los usos e indicaciones actuales de la toxina botulínica, su aplicación en dermocosmiatría, las diversas técnicas empleadas, precauciones, contraindicaciones y eventuales complicaciones

Distonias: aspectos terapêuticos / Dystonias: therapeutic aspects

Diversas abordagens terapêuticas sao utilizadas em pacientes com distonias. Sempre que possível, causas específicas devem ser identificadas e tratadas. As modalidades de tratamento sintomático podem ser agrupadas em três categorias: tratamento farmacológico, cirúrgico e injeçoes locais de toxina botulínica. Cada uma dessas modalidades apresenta algumas vantagens e limitaçoes. Formas generalizadas, particularmente as de ocorrência na infância, podem se beneficiar com drogas anticolinérgicas ou, em alguns casos, com a levodopa ou outros agentes tais como antagonistas da dopamina, baclofeno e benzodiazepínicos. As formas focais nao respondem adequadamente ao tratamento farmacológico sistêmico mas beneficiam-se significativamente com injeçoes de toxina botulínica nos grupos musculares acometidos. Cerca de 90 por cento dos pacientes com blefarospasmo e 70 por cento daqueles com distonia cervical apresentam resposta satisfatória a esse tipo de terapia. O tratamento cirúrgico tem sido utilizado em algumas formas de distonias generalizadas (lesoes estereotáxicas), axiais (rizotomias) ou focais (miectomias e neurectomias) com resultados variáveis.