Botulinum toxin—physiology and applications in head and neck disorders

Keir, James

doi:10.1002/hed.20247

Cited by 11 publications

(16 citation statements)

References 96 publications

(95 reference statements)

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“…However, Lee et al [12] reported a statistically signiWcant decrease in self-assessment pain with the injection of botulinum toxin type A, but at the end of the study patients showed only partial improvement. Some disadvantages of this therapy are: as in other applications, patients experience relapse of FBS symptoms 4-6 months later; there are some cases of resistance associated with frequent administrations (neutralizing antibody production); there are adverse eVects and it is an expensive continuous therapy [5,12,15].…”

Section: Discussionmentioning

confidence: 98%

“…The most recent treatment proposed for FBS is the use of botulinum toxin as a blocker of the presynaptic release of acetylcholine, paralyzing the myoepithelial cells, thus inhibiting the supramaximal contraction and improving the pain [5,12,15]. The fact that the botulinum toxin is used with success in other otorhinolaryngology diseases (i.e., spasmodic dysphonia, Frey's syndrome), as a simple, safe and low morbidity procedure, leads some authors to believe and defend that this should be the main therapeutic option in FBS [5].…”

Section: Discussionmentioning

confidence: 99%

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First-bite syndrome in oncologic patients

Costa

Araujo

Filipe

et al. 2011

Eur Arch Otorhinolaryngol

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First-bite syndrome (FBS) is described as a complication of parapharyngeal space surgery and consists of short-term pain in the parotid or mandibular region at the start of each meal, usually on the first bite and improving with subsequently each bite. The pathogenesis is related to a selective sympathetic denervation of the parotid gland and its treatment involves dietary modifications, medical treatment or even surgery, all with poor results. FBS is often undervalued and misdiagnosed, yet it is a pathology that may interfere with the patient's quality of life. We report two patients who underwent major cervical oncologic surgeries. One patient was subject to extended radical neck dissection into the parapharyngeal space and the other patient ligation of the external carotid artery, which post-operatively developed into FBS unresponsive to the medical treatment instituted. During external adjuvant radiotherapy, both had an unexpected FBS improvement, remaining asymptomatic after 7 and 10 months of follow-up. In this study, we discuss why FBS is misdiagnosed in oncologic patients, the possible pathophysiological mechanisms of radiotherapy and its plausibility as a new modality of treatment in selected cases.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

First-bite syndrome in oncologic patients

Costa

Araujo

Filipe

et al. 2011

Eur Arch Otorhinolaryngol

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“…Botulinum toxin type A acts at the neuromuscular junction by blocking vesicle transport of acetylcholine, and in essence, this produces a chemical denervation (13, 14). It has been used safely and effectively to control the symptoms of patients with disorders of a neural origin and voice disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Botulinum toxin type A (Botox®, Allergan, Irvine, CA, USA) is known to be a potent neurotoxin that produces flaccid paralysis of the striated muscle for a period of 2 to 6 months; it has been safely used in humans in the clinical field for more than 20 yr. Its application to the ENT field provides a useful tool to treat spasmodic dysphonia, autonomic dysfunction, Frey syndrome, hemifacial spasm or synkinesis, and hyperfunctional lines (13, 14). Gassner and Sherris (15) reported that the chemoimmobilization of facial wounds with Botox improved the cosmetic appearance.…”

Section: Introductionmentioning

confidence: 99%

Effect of Botulinum Toxin Type A on a Rat Surgical Wound Model

Lee

Jeong

Wang

et al. 2009

Clin Exp Otorhinolaryngol

101

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ObjectivesThe tension on a wound is one of the important factors that determine the degree of fibrosis and scar formation. We hypothesized that local botulinum toxin type A (Botox) induced paralysis of the musculature subjacent to a surgical wound with a skin defect would minimize the repetitive tensile forces on the surgical wound's edges, and this will result in a decreased fibroplastic response and fibrosis of the wound.MethodsThis is a prospective randomized experimental study. Two distinct surgical wounds were made to the dorsum of 15 adult rats, respectively. One of the 2 wounds was injected with Botox, and the other wound was used as a control, and this was done for all the rats' wounds. We evaluated the wound size, the degree of fibrosis and inflammation, the blood vessel proliferation, the thickness of the wound and the expression of transforming growth factor (TGF)-β1 in the wounds.ResultsThere were significant differences of wound size at the 3rd and 4th week between the Botox and control groups (P<0.05). The Botox group showed less infiltration of inflammatory cells than the control group at the 2nd week (P<0.05). The Botox group showed a smaller number of fibroblasts and less fibrosis than the control group at the 4th week (P<0.05). The Botox group showed much strong collagen density than the control group at the 8th week (P<0.05). For the immunohistochemical staining, there was a lower transforming growth factor (TGF)-β1 expression in the Botox group than that of the control group at the 4th week (P<0.05).ConclusionThe wounds of the Botox-treated group showed a larger wound size, less infiltration of inflammatory cells and less fibrosis, a much greater amount of collagen and a lower expression of TGF-β1 than did the control group. Botox might be used to decrease the fibrosis of a surgical wound without damaging the epithelial growth in situations for which decreased fibrosis is necessary, such as for treating laryngeal, tracheal and nasal stenosis.

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“…1 The author reviewed the physiologic features and clinical applications of botulinum toxin in the head and neck area. Although the author evaluated many previous studies, one of the new and important applications of the botulinum toxin, allergic rhinitis, was not included.…”

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confidence: 99%

Letter to the editor

Ünal

2006

Head & Neck

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Botulinum toxin—physiology and applications in head and neck disorders

Cited by 11 publications

References 96 publications

First-bite syndrome in oncologic patients

First-bite syndrome in oncologic patients

Effect of Botulinum Toxin Type A on a Rat Surgical Wound Model

Letter to the editor

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