• Archives of Plastic Surgery
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• 제36권3호
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• pp.283-288
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• 2009

Purpose: Frey's syndrome is a common complication after parotid surgery and characterized by gustatory sweating and flushing in the periauricular area during meals. Although a variety of methods have been proposed to prevent this postoperative problem but they have been unsatisfactory. In this article, therefore, botulinum toxin A was used to treat nine patients with Frey's syndrome and its duration effect after injection was investigated. Methods: Nine patients became the object of study about the effect of botulinum toxins as treatment of Frey's syndrome. Age of patients ranged from 25 to 78 years (mean, 43.7 years). Six of nine patients had both symptoms of gustatory sweating and flushing. And the others had only gustatory sweating symptom. Using Minor starch iodine test, the affected skin area was detected, and it was marked by $1cm^2$ sized grid appearance. After application of EMLA cream on the gustatory sweating area, botulinum toxin A was injected intracutaneously into the affected skin area ($2.5U/cm^2$). Patients were followed up from six to fifteen months (mean, about 12 months) and asked about improvement of their symptoms. Results: The treatement with botulinum toxin A took effective within two days after injection. Six months after injection, gustatory sweating disappeared completely in all patients, and five of six patients who had gustatory flushing improved in their symptom. Last follow-up, no patients complained of recurrent gustatory sweating and flushing except one. One patient, seven months after initial injection, was retreated with botulinum toxin A because of recurrence, and the result was successful. The duration of the effect after botulinum toxin A treatment was ranged from seven to thirteen months. One patient in our series experienced the upper eyelid weakness as adverse effect, but it improved spontaneously. Conclusion: Local injection of botulinum toxin A is an effective, safe and long - lasting method for treatment of Frey's syndrome. Hereafter, however, additional study will be required to evaluate the duration effect of botulinum toxin A according to frequency in use and dosage.

• 대한후두음성언어의학회지
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• 제23권2호
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• pp.111-118
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• 2012

Botulinum toxin is a potent neurotoxin that is produced by the bacterium Clostridium botulinum. The agent causes muscle paralysis by preventing the release of acetylcholine at the neuromuscular junction of striated muscle. Botulinum toxin A (Botox, AllerganInc., Irvine, California) is the most potent of seven distinct toxin subtypes that are produced by the bacterium. The toxin was initially used clinically in the treatment of strabismus caused by hypertonicity of the extraocular muscles and was sub-sequently described in the treatment of multiple disorders of muscular spasticity and dystonia. In treating patients with Botox for blepharospasm, Carruthers and Carruthers [5] noticed an improvement in glabellar rhytids. This ultimately led to the introduction and development of Botox as a mainstay in the treatment of hyperfunctional facial lines in the upper face. Since its approval by the U.S. Food and Drug Administration for the treatment of facial rhytids (2002), botulinum toxin A has expanded into wide-spread clinical use. Forehead, glabellar, and periocular rhytids are the most frequently treated facial regions. Indications for alternative uses for Botox in facial plastic and reconstructive surgery are expanding. These include a variety of well-established procedures that use Botox as an adjunctive agent to enhance results. In addition, Botox injection is finding increased usefulness as an independent modality for facial rejuvenation and rehabilitation. The agent is used beyond its role in facial rhytids as an effective agent in the management of dynamic disorders of the face and neck. Botox injection allows the physician to precisely manipulate the balance between complex and conflicting muscular interactions, thus resetting their equilibrium state and exerting a clinical effect. This article will address some of the new and unique indications on Botox injection in the face (the lower face and neck, combination with fillers). Important points in terms of its clinical relevance will be stressed, such as an understanding of functional facial anatomy, the importance of precise injections, and correct dosing all are critical to obtaining natural outcomes.

• 구강회복응용과학지
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• 제23권2호
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• pp.171-178
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• 2007

Botulinum toxin type A (BTX-A) has a local effect at the neuromuscular junction by blocking acetylcholine release and thus causing paralysis and atrophy of the affected muscles. In dentistry, Botulinum toxin type A(BTX-A) is used for the treatment of masseteric hypertrophy, temporomandibular disorder, and severe bruxism related neurologic disorder. We hypothesized that the muscle atrophy after BTX-A injection into masseter muscle in growing rats, could affect the jaw growth. The purpose of this study was to determine the effects of the BTX-A injected into the masseter muscle on the jaw growth in rats. Rats were divided into four groups(group 1; control group, group 2; saline injection group, group 3; BTX-A injection group, group 4; baseline control group). Group 4 was sacrificed at the beginning of the experiment to provide baseline values of jaw measurements. The weight, length and width of jaw in those groups were measured every weeks. This study reported that the mandibular body length, condylar length, coronoid process length, anterior region height, coronoid process height and condylar height of the jaw in BTX-A injection group were shorter than those of the control and saline injection groups(P<0.05). In conclusion, BTX-A injected into the masseter muscle may affect the undergrowth of the jaw in rats.

• Clinical Pain
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• 제19권1호
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• pp.49-53
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• 2020

Piriformis muscle syndrome is a condition that causes direct muscle pain around piriformis muscle or sciatica from irritated sciatic nerve and the diagnosis remains debatable. The main treatment is symptomatic relief from conservative therapy such as medication and piriformis stretching exercise, and various therapeutic injections including local anesthetic, corticosteroid, botulinum toxin can be considered for diagnostic and therapeutic purposes. In this case, a 54-year-old male who had sciatica and gait disturbance showed piriformis muscle hypertrophy in the pelvis MRI. From imaging studies, electrodiagnostic study and physical examination, he was diagnosed with piriformis muscle syndrome. He underwent trigger point injection and botulinum toxin injection into the piriformis muscle, and pain and gait disturbance significantly improved. This case reports a case of piriformis muscle syndrome with clinical symptom of gait disturbance, which was improved by botulinum toxin injection.

• 대한후두음성언어의학회지
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• 제20권1호
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• pp.21-24
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• 2009

Various laryngeal injection techniques andmaterials have been introduced and widelyused. In this section, office-base laryngeal injection with Cidofovir, Steroid and Botulinum toxin will be described including a suitable approach for the injection, treatment efficacy, side effects and its pitfalls.

• 대한후두음성언어의학회지
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• 제30권1호
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• pp.12-14
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• 2019

Functional dysphonia (FD) is a disease entity which includes various voice disorders in the absence of structural or neurologic laryngeal pathology. Muscle tension dysphonia (MTD), psychogenic dysphonia are representative FD with completely different pathogenesis. Therefore there is no standard treatment modality for FD, the first step of treatment of FD is differentiating patient's voice symptoms from other organic voice disorders and other functional voice problems. MTD is a functional voice disorder caused by hyperfunction of intrinsic and extrinsic laryngeal musculature. Symptoms include increased vocal effort, roughness, fatigue and odynophonia. First line for MTD is indirect or direct voice therapy. Unfortunately, many patients with MTD improve with voice therapy alone. For these patients, various modalities tried; lidocaine application, surgical excision of the false vocal folds, and botulinum toxin injection, etc. Botulinum toxin injections are widely used in the field of otolaryngology, especially for spasmodic dysphonia. However, its use in FD or MTD has only been described in few case reports. The aim of this lecture is to evaluate the feasibility of botulinum toxin injection for FD, especially MTD.

• Archives of Plastic Surgery
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• 제32권3호
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• pp.311-313
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• 2005

Generally, many Asian women tend to dislike the square jaw, as they believe it makes the face look wider, giving a stubborn and strong impression. Contouring of the mandible is therefore a relatively common aesthetic procedure among Asians. These days, the use of botulinum toxin for contouring of the lower face offer simple alternative to surgery. Motor point, which is the site over a muscle where its contraction may be elicited by a minimal intensity short duration electrical stimulus, is the optimal injection point of botulinum toxin. Study was undertaken to identify the location of motor point of the masseter muscle and the skin surface landmark. First, the thickest point of the masseter muscle was inspected through palpation and inspection by 3 different individual plastic surgeons and then compound muscle action potentials(CMAPs) of masseter muscle in 15 health volunteers were recorded using EMG. For the localization of the measured points, line between lateral canthus to the mandibular angle was used. Location of motor points were mapped to skin surface from lateral canthus in a percentage of the distance along the landmark line and in distance in millimeters. The clinical injection point was located at 71.69 percentile and 7.3 mm of the landmark line. The motor point test was located at 72.54 percentile and 7.1 mm of the landmark line. The depth of motor point was 16mm. There was no statistically significant difference between the clinical injection point and the motor point. We conclude that surface mapping of motor point of the masseter muscle would increase accessibility and accuracy in botulinum toxin injection for contouring of the lower face.

• 대한후두음성언어의학회지
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• 제11권2호
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• pp.185-187
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• 2000

The etiology of vocal fold granuloma was identified : post-endotracheal intubation, vocal abuse, acid reflux and idiopathic. The identification of the cause or causal factor is important, since the treatment must be fundamental directed at them. Treatment have included voice therapy and antireflux measures. Surgical excision is considered in patients who do not respond to medical management. In this study, a case of vocal fold granuloma resolved who underwent injection of the affected vocal fold. Botulinum toxin type A is probably successful by decreasing the strength during adduction in the arytenoid region which, when very intense, would perpetuate the granuloma. Localized injection of this neurotoxin is promising both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy.

• 한국임상수의학회지
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• 제35권2호
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• pp.50-52
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• 2018

A 6-month-old castrated male poodle presented with a cough, dysphagia, and regurgitation. Cricopharyngeal achalasia (CPA) was diagnosed by clinical history and a fluoroscopic examination. The animal received a botulinum toxin (BTX) injection but symptoms had not resolved by three days after injection. Thus, a cricopharyngeal and thyropharyngeal muscle myotomy was performed and immediately the clinical signs resolved. This report describes successful correction of CPA with myotomy after failure of BTX injection in a dog.

• 대한통합의학회지
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• 제9권2호
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• pp.105-108
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• 2021

Background : Hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is a rare, autosomal recessive metabolic disorder which is caused by genetic mutations that disrupt the urea cycle. It is characterized by variable clinical presentation and the age of onset. Patients may present with gait disturbance and progressive paraplegia and muscle tightness in the lower extremities. The use of botulinum toxin in metabolic disease has rarely been discussed. We describe a case of a 14-year-old-boy with HHH syndrome, who presented with a several - month history of gait disturbance and lower extremity weakness. Case presentation : A 14-year old male had a history of recurrent upper respiratory tract infections, occasional vomiting, loss of appetite, and general weakness, all of which started since he was 10 months old. He was diagnosed with HHH syndrome at one year of age. At the age of 14, he was referred for the assessment and treatment of his gait disturbance and aggravated weakness of the lower extremities. Brain MRI, electrodiagnostic study and blood test were performed to exclude any lesions related to neurologic dysfunction. Botulinum toxin type A were injected into muscles of adductor longus, adductor magnus, lateral and medial hamstring, and lateral and medial gastrocnemius muscle heads under needle electromyography guidance to reduce lower limb spasticity. Intensive physical therapy including gait training and stretching exercise of adductor and calf muscles were also provided. After intensive physical therapy and botulinum toxin injection to reduce lower limb spasticity, he was able to ambulate for 20 meters independently without any walking aids. There were no adverse events after the injection. Conclusion : Botulinum toxin injection is a safe and effective therapy for patients with HHH syndrome who suffer from gait disturbance.