Botulinum toxin treatment for facial palsy: A systematic review

Cooper, Lilli; Lui, Michael S.; Nduka, Charles

doi:10.1016/j.bjps.2017.01.009

Cited by 101 publications

(93 citation statements)

References 16 publications

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“…Of roughly 300 patients receiving botulinum toxin for synkinesis annually at our center, we perform 15 platysmectomies, four depressor anguli oris muscle resections, and two 2HSN procedures. Chemodenervation with botulinum toxin remains first‐line treatment of synkinesis in facial palsy …”

Section: Discussionmentioning

confidence: 99%

“…Chemodenervation with botulinum toxin remains first-line treatment of synkinesis in facial palsy. [6][7][8] Selective neurectomy has been described for the treatment of facial synkinesis over half a century ago. 14 Recently, there has been renewed interest among facial nerve specialists in the surgical treatment of synkinesis, although this is unsupported by long-term data.…”

Section: Discussionmentioning

confidence: 99%

“…First‐line treatment for synkinesis is chemodenervation with botulinum toxin combined with physical therapy, which generally achieves good results . However, a subset of patients does not respond to this approach or develop resistance to botulinum toxin after years of treatment.…”

Section: Introductionmentioning

confidence: 99%

“…First-line treatment for synkinesis is chemodenervation with botulinum toxin combined with physical therapy, which generally achieves good results. [6][7][8] However, a subset of patients does not respond to this approach or develop resistance to botulinum toxin after years of treatment. For these refractory patients, several surgical techniques have been described, including neurectomy, myectomy, and nerve transfers.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcome of selective neurectomy for refractory periocular synkinesis

2018

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ObjectiveThe objective of this study was to investigate the long‐term effect and treatment stability of selective neurectomy for refractory periocular synkinesis.MethodsWe performed a retrospective review of all patients treated with highly selective neurectomy for refractory periocular synkinesis between August 2009 and August 2015. Primary outcome was time to recommencing treatment for periocular synkinesis. Palpebral fissure width was measured preoperatively, postoperatively, and at long‐term ( > 2.5 years) follow‐up. Mean units of botulinum toxin used pre‐ and postoperatively were compared.ResultsOf the 12 patients, 10 could be included. Only one was free of treatment for periocular synkinesis at a follow‐up of 3.5 years. The other nine patients recommenced treatment with botulinum toxin after a median time of 1.2 (interquartile range 0.6–2.6) years. Palpebral fissure width while smiling was significantly different between the pre‐ and postoperative (P = 0.008) and preoperative and long‐term (P = 0.008) measurements. Postoperatively, previously refractory patients demonstrated good response to botulinum toxin treatments.ConclusionThis study demonstrates that most patients require renewed pharmacological treatment of periocular synkinesis after neurectomy. Although the effect of neurectomy in the treatment of refractory synkinesis does not appear to be sustained, patients usually experience a symptom‐free interval and demonstrate larger palpebral fissure width at long‐term follow‐up compared to preoperative measurements.Level of Evidence4. Laryngoscope, 128:2291–2295, 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long‐term outcome of selective neurectomy for refractory periocular synkinesis

2018

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“…(Salles, 2006). Estudos clínicos mostraram que a melhora na simetria se deve não apenas à redução temporária do movimento muscular pela ação da toxina no lado não paralisado mas também à melhora funcional persistente, mesmo após o término da ação da droga, do lado paralisado (Salles et al, 2009;Monini et al, 2011;Azuma et al, 2012;Salles e Ferreira, 2012;Choi et al, 2013;Kim, 2013;Salles, 2013;Do Nascimento Remigio et al, 2015;Salles et al, 2015;Cooper et al, 2017).…”

Section: Massa Corporalunclassified

Recuperação funcional após aplicação de toxina abobotulínica A no músculo gastrocnêmio contralateral ao reparo do nervo tibial em ratos

Lima¹

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Comparison of Myelin-Associated Glycoprotein With Vincristine for Facial Nerve Inhibition After Bilateral Axotomy in a TransgenicThy1-GfpRat Model

Ali

Hanks

Stebbins

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Aberrant synkinetic movement after facial nerve injury can lead to prominent facial asymmetry and resultant psychological distress. The current practices of neuroinhibition to promote greater facial symmetry are often temporary in nature and require repeated procedures.OBJECTIVE To determine whether myelin-associated glycoprotein (MAG), a specific neuroinhibitor, can prevent neuroregeneration with efficacy comparable with that of vincristine, a well-established neurotoxin.DESIGN, SETTING, AND PARTICIPANTS Rats transgenic for Thy-1 cell surface antigen-green fluorescent protein (Thy1-Gfp) were randomized into 3 groups. Each rat received bilateral crush axotomy injuries to the buccal and marginal mandibular branches of the facial nerves. The animals received intraneural injection of saline, MAG, or vincristine. MAIN OUTCOMES AND MEASURESThe animals were imaged via fluorescent microscopy at weeks 1, 3, 4, and 5 after surgery. Quantitative fluorescent data were generated as mean intensities of nerve segments proximal and distal to the axotomy site. Electrophysiological analysis, via measurement of compound muscle action potentials, was performed at weeks 0, 3, 4, and 5 after surgery.RESULTS A total of 12 rats were included in the study. Administration of MAG significantly reduced fluorescent intensity of the distal nerve in comparison with the control group at week 3 (mean [SD], MAG group: 94 [11] intensity units vs control group: 130 [11] intensity units; P < .001), week 4 (MAG group: 81 [19] intensity units vs control group: 103 [9] intensity units; P = .004), and week 5 (MAG group: 76 [10] intensity units vs control group: 94 [10] intensity units; P < .001). In addition, rats treated with MAG had greater fluorescent intensity than those treated with vincristine at week 3 (mean [SD], MAG group: 94 [11] intensity units vs vincristine group: 76 [6] intensity units; P = .03), although there was no significant difference for weeks 4 and 5. At week 5, both MAG and vincristine demonstrated lower distal nerve to proximal nerve intensity ratios than the control group (control group, 0.94; vs MAG group, 0.82; P = .01; vs vincristine group; 0.77; P < .001). There was no significant difference in amplitude between the experimental groups at week 5 of electrophysiological testing.CONCLUSIONS AND RELEVANCE Lower facial asymmetry and synkinesis are common persistent concerns to patients after facial nerve injury. Using the Thy1-Gfp rat, this study demonstrates effective inhibition of neuroregeneration via intraneural application of MAG in a crush axotomy model, comparable with results with vincristine. By potentially avoiding systemic toxic effects of vincristine, MAG demonstrates potential as an inhibitor of neural regeneration for patients with synkinesis.LEVEL OF EVIDENCE NA.

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Botulinum toxin treatment for facial palsy: A systematic review

Cited by 101 publications

References 16 publications

Long‐term outcome of selective neurectomy for refractory periocular synkinesis

Long‐term outcome of selective neurectomy for refractory periocular synkinesis

Recuperação funcional após aplicação de toxina abobotulínica A no músculo gastrocnêmio contralateral ao reparo do nervo tibial em ratos

Comparison of Myelin-Associated Glycoprotein With Vincristine for Facial Nerve Inhibition After Bilateral Axotomy in a TransgenicThy1-GfpRat Model

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