Botulinum toxin in the management of facial paralysis

Cabin, Jonathan; Massry, Guy G.; Azizzadeh, Babak

doi:10.1097/moo.0000000000000176

Cited by 60 publications

(35 citation statements)

References 49 publications

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“…Facial synkinesis is a difficult disorder to treat, often requiring both a combined medical and surgical approach. Chemodenervation is successful in providing temporary relief and improved quality of life by taking advantage of clostridium botulinum's distinct neurotoxic effects . In a 1996 meta‐analysis, Dutton et.…”

Section: Discussionmentioning

confidence: 99%

“…Facial synkinesis is the involuntary contraction of muscles in combination with voluntary movements that develop after facial denervation or nerve injury. The treatment of the disorder is predominantly physical therapy and chemodenervation, with select adjunct surgical procedures . There are several agents used for chemodenervation, although all contain the clostridium botulinum neurotoxin.…”

Section: Introductionmentioning

confidence: 99%

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Contemporary Review and Case Report of Botulinum Resistance in Facial Synkinesis

et al. 2018

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Background Botulinum resistance poses significant treatment challenges for both patients and healthcare practitioners. We first present a case highlighting botulinum resistance in a patient who failed to respond to alternative formulations but who responded remarkably to incobotulinum toxinA, an identical toxin free of complexing proteins. Secondly, we provide a treatment algorithm and a review of the literature detailing clinical and immunochemical botulinum resistance. Results Patients with botulinum resistance show a predisposition to failure on subsequent injections and possess a propensity toward neutralizing and nonneutralizing antibody development. The mechanisms of resistance are not entirely understood but thought to be secondary to an immunologic response. Risk factors for resistance include higher botulinum doses, more frequent injections, and high total lifetime dosage. Patients may still respond to other botulinum formulations or subtypes; however, this effect may be temporary. Conclusion This case report describes a patient who responded to incobotulinum toxinA after failing treatment with the identical toxin compounded with buffer proteins, ultimately supporting the possibility of immune‐mediated resistance to the surrounding proteins and not the toxin itself. Often, impending treatment resistance is preceded by a poor or limited clinical response. Antibody testing is not indicated because it is neither sensitive nor specific and does not change clinical practice. Initially, higher doses of botulinum may overcome resistance without increasing treatment frequency, and side effects are far less common in those with clinical resistance. If higher dosages fail to produce a response, alternative botulinum formulations or subtypes can be considered. Laryngoscope, 129:2269–2273, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Contemporary Review and Case Report of Botulinum Resistance in Facial Synkinesis

et al. 2018

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“…Numerous studies have demonstrated the ability of botulinum toxin to treat synkinesis and hypertonicity in patients with NFFP. 9,10,29,30 Chemodenervation for NFFP is associated with improved clinician-graded assessment of facial palsy severity and patient-reported QOL scores. 31,32 Not only can botulinum toxin be used to improve hypertonicity and synkinesis, but it can also be administered to musculature on the healthy side to improve symmetry.…”

Section: Management Of Nffp Historical Treatmentsmentioning

confidence: 99%

Beyond Botox: Contemporary Management of Nonflaccid Facial Palsy

Miller

Hadlock

2020

Facial Plastic Surgery & Aesthetic Medicine

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Many transient facial nerve insults, including Bell's palsy, Ramsay Hunt syndrome, Lyme-associated facial paralysis, and temporal bone fractures, ultimately lead to nonflaccid facial palsy (NFFP). NFFP is associated with significant functional, aesthetic, psychological, and social impairments. However, algorithms for comprehensive management of this entity are not well developed and are rapidly evolving. Herein, we present our current approach to NFFP, with the goal of providing a framework that may be applied to this complex patient population.

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“…17,100 Ultimately, facial reanimation outcomes may be optimized with multimodal approaches utilizing a combination of chemodenervation as well as static and dynamic procedures to address functional and aesthetic impairment. 101…”

Section: Surgical Management Of Facial Paralysismentioning

confidence: 99%

Modern Management of Facial Nerve Disorders

2020

Self Cite

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Facial paralysis is a devastating condition, encompassing a spectrum of disorders, with resultant psychosocial, functional, and aesthetic sequelae. With this in mind, an individualized treatment approach based on the cause, pattern, and duration of palsy is necessary. Treatment options include pharmacologic agents, corneal protective interventions, physical therapy, and surgical procedures. The use of steroids and antivirals in the setting of idiopathic facial paralysis or virus-associated facial paralysis is well supported. Despite the diversity of surgical interventions described, there is a lack of consensus regarding optimal treatment. This article provides an overview of the current management of facial paralysis. Medical, surgical, and physical treatment options are discussed with a review of the relevant literature.

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Botulinum toxin in the management of facial paralysis

Cited by 60 publications

References 49 publications

Contemporary Review and Case Report of Botulinum Resistance in Facial Synkinesis

Contemporary Review and Case Report of Botulinum Resistance in Facial Synkinesis

Beyond Botox: Contemporary Management of Nonflaccid Facial Palsy

Modern Management of Facial Nerve Disorders

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