• The Journal of the Korean dental association
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• v.55 no.10
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• pp.696-705
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• 2017

Condylar fractures account for one-third of all mandibular fractures. There are many surgical methods for the open reduction of condylar fractures, such as the transoral, submandibular, preauricular, and retromandibular approaches. Two patients suffering from condylar fractures, a 45-year-old man and a 25-year-old man, were admitted to our hospital. Both patients' condylar fractures were positioned too high for us to use the transoral approach. Therefore, we employed the retromandibular method to expedite the approach to the fracture site and minimize the size of the incision. After the surgical procedures in both cases, we experienced complications in the form of parotid gland fistulae, which rarely result from the retromandibular approach. A combination of botulinum toxin injection and amitriptyline medication was effective for the management of these parotid gland fistulae. Here, we report these two cases and offer a review of the literature on this article.

• Journal of Oral Medicine and Pain
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• v.46 no.4
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• pp.143-149
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• 2021

Purpose: Oromandibular dystonia is a neurological disorder that affects the jaw and lower face muscles, often resulting in abnormal repetitive movement of the jaw and perioral structures. The purpose of this study was to assess the effectiveness of surface electromyography (EMG) in evaluating the treatment outcome of oromandibular dystonia. Methods: Based on a retrospective review of medical records, we analyzed the data of four patients who received medication or botulinum toxin injection, as well as surface EMG of the jaw muscles before and after treatment. We assessed the patients' clinical characteristics and the results of surface EMG before and after treatment. Results: The case series included one female and three males, and the age range was 65-78 years. Based on the clinical features, two subjects were classified as jaw deviation and the remaining two were as jaw closing. Dystonic patterns revealed by surface EMG varied, including phasic, tonic, and mixed contraction patterns. EMG amplitude after treatment was lower than pre-treatment value in all four subjects, suggesting improved clinical signs and symptoms. One subject who received clonazepam and another who received botulinum toxin injection showed a remarkable reduction in EMG amplitude within a normal range. Conclusions: Surface EMG can be used to effective evaluate treatment outcomes in patients with oromandibular dystonia. It could be considered as an adjunctive diagnostic tool in managing patients with dystonia.

• Journal of Oral Medicine and Pain
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• v.30 no.1
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• pp.121-129
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• 2005

In this experiment, eleven volunteers were followed up for 15 months after the injection of botulinum toxin type A on right and left masseter muscles. The measurement of masseter muscle atrophy for each volunteer was performed by CT(computed tomography) three times: before the injection, three and fifteen months after the injection. The thickness and area of muscle were measured in three positions which are 10 (position 1), 20 (position 2), and 40 mm (position 3) above the inferior border of mandible(the injection site was nearest the position 1). The thickness of masster muscle was decreased in all three positions three months after the injection, but no significant change was observed fifteen months after the injection. On the other hand, the area of masster muscle was decreased in all three positions three months after the injection. Furthermore, the area was decreased significantly in positions 1 and 2, but not in position 3 fifteen months after the injection. As a result, toxin is still in effect even fifteen months after the injection. Finally, the present study shows that the measurement of muscle area provides more precise informations than that of muscle thickness does.

• Journal of Oral Medicine and Pain
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• v.39 no.2
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• pp.55-62
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• 2014

Purpose: This study aims to evaluate the changes in soft tissue thickness of the masseteric region after injection of botulinum toxin type A (BTX-A). Methods: Twenty-four data acquired from medical records were classified into 4 groups: bruxer group that received masseter muscle injection only (M-B), bruxer group that received both masseter and temporalis muscle injections (MT-B), non-bruxer group that received masseter muscle injection only (M-NB) and non-bruxer group that received both masseter and temporalis muscle injections (MT-NB). Injection dose of BTX-A was 30 units for each masseter muscle and 20 units for each temporalis muscle. We measured the reduced thickness of the masseteric region before and after 12 weeks after injection using cone-beam computed tomography. Results: Among the patients that received both masseter and temporalis muscle injections, bruxer group showed a tendency to have more reduction in masseter muscle thickness than non-bruxer group. The difference in reduced thickness between M-B and MT-B tended to show greater than the difference between M-NB and MT-NB. Conclusions: In case of masseter hypertrothy patients with bruxism there was a tendency to show a difference in reduced thickness of soft tissue between the group that received both masseter and temporalis muscles injection and the group that received masseter muscle injection only hence a thorough inspection before the injection of BTX-A is condisered to be needed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.2
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• pp.143-149
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• 2020

Objectives: Long-term facial paralysis results in degeneration of the distal nerve segment and atrophy of the supplied muscles. Options for these patients include free muscle transfer, temporalis myoplasty, and botulinum toxin injections for smile reanimation. In this study we aimed to evaluate the subjective and objective outcomes of these procedures. Materials and Methods: In our study, we retrospectively analyzed smile symmetry in patients with facial palsy (n=8) who underwent facial reanimation procedures. Results: Subjective analysis showed high satisfaction in seven out of eight patients. Objective analysis showed statistically significant improvement postoperatively in both vertical and horizontal smile symmetry at rest and during maximum smile (P<0.001). Conclusion: Choosing the ideal procedure for the patients is the most critical aspect for facial reanimation. Though free muscle transfer is considered gold standard procedure, temporalis myoplasty also gives satisfactory results. Residual synkinesis which can lead to disturbing aesthetic deformity can be effectively treated with botulinum toxin.

• Archives of Plastic Surgery
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• v.42 no.6
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• pp.735-740
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• 2015

Background Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy. Methods Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant. Results Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01). Conclusions BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.36.1-36.5
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• 2018

Background: Botulinum toxin-A (BTX-A) injection into muscle reduces muscular power and may prevent post-operative complication after orthognathic surgery. The purpose of this study was (1) to evaluate BTX-A injection into the masseter muscle on the prevention of plate fracture and (2) to compare post-operative relapse between the BTX-A injection group and the no injection group. Methods: Sixteen patients were included in this study. Eight patients received BTX-A injection bilaterally, and eight patients served as control. All patients received bilateral sagittal split ramus osteotomy for the mandibular setback and additional surgery, such as LeFort I osteotomy or genioplasty. Post-operative plate fracture was recorded. SNB angle, mandibular plane angle, and gonial angle were used for post-operative relapse. Results: Total number of fractured plates in patients was 2 out of 16 plates in the BTX-A injection group and that was 8 out of 16 plates in the no treatment group (P = 0.031). However, there were no significant differences in post-operative changes in SNB angle, mandibular plane angle, and gonial angle between groups (P > 0.05). Conclusions: BTX-A injection into the masseter muscle could reduce the incidence of plate fracture.

• The Korean Journal of Pain
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• v.35 no.4
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• pp.391-402
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• 2022

Background: The mechanism of peripheral axon transport in neuropathic pain is still unclear. Chemokine ligand 13 (CXCL13) and its receptor (C-X-C chemokine receptor type 5, CXCR5) as well as GABA transporter 1 (GAT-1) play an important role in the development of pain. The aim of this study was to explore the axonal transport of CXCL13/CXCR5 and GAT-1 with the aid of the analgesic effect of botulinum toxin type A (BTX-A) in rats. Methods: Chronic constriction injury (CCI) rat models were established. BTX-A was administered to rats through subcutaneous injection in the hind paw. The pain behaviors in CCI rats were measured by paw withdrawal threshold and paw withdrawal latencies. The levels of CXCL13/CXCR5 and GAT-1 were measured by western blots. Results: The subcutaneous injection of BTX-A relieved the mechanical allodynia and heat hyperalgesia induced by CCI surgery and reversed the overexpression of CXCL13/CXCR5 and GAT-1 in the spinal cord, dorsal root ganglia (DRG), sciatic nerve, and plantar skin in CCI rats. After 10 mmol/L colchicine blocked the axon transport of sciatic nerve, the inhibitory effect of BTX-A disappeared, and the levels of CXCL13/CXCR5 and GAT-1 in the spinal cord and DRG were reduced in CCI rats. Conclusions: BTX-A regulated the levels of CXCL13/CXCR5 and GAT-1 in the spine and DRG through axonal transport. Chemokines (such as CXCL13) may be transported from the injury site to the spine or DRG through axonal transport. Axon molecular transport may be a target to enhance pain management in neuropathic pain.

• Journal of Oral Medicine and Pain
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• v.48 no.1
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• pp.16-24
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• 2023

Purpose: To determine the effects of botulinum toxin (BoNT) injection into the human masseter muscle on the morphology of the mandibular condyle bone using cone-beam computed tomography (CBCT). Methods: Twenty volunteers were randomly assigned to one of two groups. Group I received a single BoNT injection; Group II received two injections, with the second being administered 4 months after the first. CBCT scans of both temporomandibular joints (TMJs) were performed before and 6 months after the first injection. Bony changes in the cortical layers of the condyle heads were evaluated and the long and short axes of both mandibular condyles were measured. The thickness at the thinnest part of glenoid fossa was also quantitatively measured. Results: There was no significant difference between pre- and post-injection CBCT images. Furthermore, no changes in the cortical layers of the condyle heads were observed among the subjects who exhibited mild degenerative TMJ changes. The quantitative measurements (long axis, short axis, and the thickness of thinnest part of glenoid fossa roof) did not differ significantly between pre- and post-injection except for the long axis in Group I. Conclusions: Within the limitations of this study, it appears that BoNT injections into human masseter muscles do not alter the morphology of the mandibular condyle bone in healthy adults.

• International Journal of Oral Biology
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• v.40 no.2
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• pp.71-77
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• 2015

The activation of glial cells in the spinal cord has been contribute to the initiation and maintenance of pain facilitation induced by peripheral inflammation and nerve injury. The present study investigated effects of botulinum toxin type A (BoNT-A), injected subcutaneously or intracisternally, on the expression of microglia and astrocytes in rats. Complete Freund's Adjuvant (CFA)-induced inflammation was employed as an orofacial chronic inflammatory pain model. A subcutaneous injection of $40{\mu}L$ CFA into the vibrissa pad was performed under 3% isoflurane anesthesia in SD rats. Immunohistochemical analysis for changes in Iba1 (a microglia marker) and GFAP (an astrocyte marker), were performed 5 days after CFA injection. Subcutaneous injection of CFA produced increases in Iba1 and GFAP expression, in the ipsilateral superficial lamia I and II in the medullary dorsal horn of rats. Subcutaneous treatment with BoNT-A attenuated the up-regulation of Iba1 and GFAP expressions induced by CFA injection. Moreover, intracisternal injection of BoNT-A also attenuated the up-regulated Iba1 and GFAP expressions. These results suggest that the anti-nociceptive action of BoNT-A is mediated by modulation activation of glial cells, including microglia and astrocyte.