Lacrimal gland botulinum toxin injection for epiphora management

Jeffers, Johnathan V.; Lucarelli, Katherine M; Akella, Suresh; Setabutr, Pete; Wojno, Ted H.; Aakalu, Vinay K.

doi:10.1080/01676830.2021.1966810

Cited by 13 publications

(12 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinically, complications have been shown to occur in approximately one in five patients receiving botulinum toxin injections to the lacrimal gland. 10 Interestingly, this complication rate seems to correspond to the proportion of inaccurate injections in the landmark-guided group in this study. The results of this study indicate that ultrasound guidance may reduce the incidence of these complications, of which ptosis, attributable to inadvertent paralysis of the levator palpebrae superioris, and diplopia, caused by spread to the superior or lateral rectus muscles, [42][43][44] seem to be most common.…”

Section: Injection Accuracy and Complicationsmentioning

confidence: 60%

“…There is an ongoing debate on whether lacrimal gland injections should be performed via a transcutaneous or transconjunctival route to reduce adverse effects. 10,45 The results of the current study suggest that a relevant next question might be how patient safety can be improved using ultrasound guidance.…”

Section: Injection Accuracy and Complicationsmentioning

confidence: 88%

“…The low precision of the landmark-guided injections in this study may explain the clinical complication rates reported in the literature. 8,[10][11][12][13][14][15][16][17][18][19][20][21] For example, when injecting the lacrimal gland using landmark guidance, only 8% of cases had most of the ink inside the correct target. In the remaining 92%, most of the ink was instead found in the surrounding tissue.…”

Section: Injection Accuracy and Complicationsmentioning

confidence: 99%

“…Currently, botulinum toxin injections in this area are performed using landmark-based guidance and palpation. Using this approach, complications are common, with 21% of lacrimal gland injections leading to complications 10 such as diplopia, ptosis, rectus muscle dysfunction, papillary conjunctivitis, and hematoma. 8,[10][11][12][13][14][15] When facial muscles are injected, oral incompetence, exposure keratitis, lagophthalmos, diplopia, or ptosis can occur.…”

mentioning

confidence: 99%

“…Using this approach, complications are common, with 21% of lacrimal gland injections leading to complications 10 such as diplopia, ptosis, rectus muscle dysfunction, papillary conjunctivitis, and hematoma. 8,[10][11][12][13][14][15] When facial muscles are injected, oral incompetence, exposure keratitis, lagophthalmos, diplopia, or ptosis can occur. [15][16][17][18][19][20] A double-blind, placebocontrolled study showed that injections around the eye caused lagophthalmos and exposure keratitis in 53% and 47% of cases, respectively.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors

Kildal

Rodríguez-Lorenzo

Pruidze

et al. 2023

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

otulinum toxin injection is the accepted standard treatment for facial synkinesis and gustatory hyperlacrimation, two common and disabling sequelae of facial paralysis. Synkinesis, the involuntary movement of facial muscles occurring when other facial muscles are moved voluntarily, 1 leads to functional and social problems. 2 Gustatory hyperlacrimation (commonly known as crocodile tears syndrome), that is, excessive tear production when eating and Background: Botulinum toxin injection is the accepted standard treatment for synkinesis and gustatory hyperlacrimation in patients with facial paralysis. However, poor injection accuracy can result in inconsistent treatment outcomes, variable treatment durations, and complications. Ultrasound guidance should increase injection accuracy in the facial region; however, this has not been proven. Methods: Twenty-six hemifaces of nonembalmed cadavers were studied in a randomized split-face manner. Ink was injected with ultrasound or landmark guidance into the lacrimal gland and three common synkinetic muscles: the orbicularis oculi, depressor anguli oris, and mentalis. Injection accuracy was evaluated using several measures. Results: Using ultrasound guidance, most ink (>50%) was found inside the correct target in 88% of cases, compared with 50% using landmark guidance (P < 0.001). This was most pronounced in the lacrimal gland (62% versus 8%), depressor anguli oris (100% versus 46%), and mentalis (100% versus 54%) (P < 0.05). All ink was found inside the correct target (no ink outside) in 65% using ultrasound guidance versus 29% without (P < 0.001). Injection accuracy (any ink in target) was 100% when using ultrasound guidance versus 83% without (P < 0.01). Twenty-three percent of the landmark-guided depressor anguli oris injections stained the facial artery (P = 0.22). Conclusions: Ultrasound guidance significantly increased injection accuracy and reduced the amount of ink lost in the surrounding tissue compared with landmark guidance. Clinical trials are needed to explore the effects of ultrasound guidance on treatment outcome, duration, and complications in patients with facial paralysis.

show abstract