Purified botulinum toxin (BTX) was the first bacterial toxin used as a medicine. Since its introduction into clinical use, over 30 years ago, it has become a versatile drug in various fields of medicine.
Its mechanism of inhibiting acetylcholine release at neuromuscular junctions following local injection is unique for the treatment of facial wrinkles.
Other dose-dependent anti-neuroinflammatory effects and vascular modulating properties have extended its spectrum of applications.
Botox for your TMJ (tempero mandibular joint) by Dr.Rajat Sachdeva | TMJ Pain...Dr. Rajat Sachdeva
Temporomandibular joint pain or TMJ pain is common. Botox injections can help patients who have not improved with simpler treatments.
Temporomandibular disorder is a common cause of chronic facial pain and is known to interfere with personal relations, professional duties, and overall quality of life. Appropriate diagnosis allows physicians to identify the disorder and initiate an effective therapeutic plan. Botulinum toxin can provide long-term relief of TMD by reducing the intensity, frequency, and duration of recurrent episodes. Adverse effects from BoNT injections are uncommon, mild and transient making it an attractive option for adjunctive therapy for myofascial TMD in patients who have failed initial conservative therapy and systemic pharmacotherapy.
Temporomandibular disorders (TMDs) are considered the major cause of orofacial pain. Internal derangement (ID) of the temporomandibular joint (TMJ), which is classified as disc displacement with or without reduction, is one of the disorders of the TMJ that is frequently seen.
Displacement of the articular disc can result in decreased joint space, joint noise (clicking, popping, or crepitation), arthritis, condylar resorption, inflammation, and compression of the bilaminar tissue, all of which can cause various degrees of pain and dysfunction.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
Botox for your TMJ (tempero mandibular joint) by Dr.Rajat Sachdeva | TMJ Pain...Dr. Rajat Sachdeva
Temporomandibular joint pain or TMJ pain is common. Botox injections can help patients who have not improved with simpler treatments.
Temporomandibular disorder is a common cause of chronic facial pain and is known to interfere with personal relations, professional duties, and overall quality of life. Appropriate diagnosis allows physicians to identify the disorder and initiate an effective therapeutic plan. Botulinum toxin can provide long-term relief of TMD by reducing the intensity, frequency, and duration of recurrent episodes. Adverse effects from BoNT injections are uncommon, mild and transient making it an attractive option for adjunctive therapy for myofascial TMD in patients who have failed initial conservative therapy and systemic pharmacotherapy.
Temporomandibular disorders (TMDs) are considered the major cause of orofacial pain. Internal derangement (ID) of the temporomandibular joint (TMJ), which is classified as disc displacement with or without reduction, is one of the disorders of the TMJ that is frequently seen.
Displacement of the articular disc can result in decreased joint space, joint noise (clicking, popping, or crepitation), arthritis, condylar resorption, inflammation, and compression of the bilaminar tissue, all of which can cause various degrees of pain and dysfunction.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
This powerpoint describes the types of maxillectomy & operative steps for total maxillectomy. It also enumerates various flaps used for reconstruction of maxillectomy defect.
Detailed description of diagnosis and management of maxillofacial and neck space infections. Discussion of anatomy of the spaces is also done in details. Drainage of such spaces are also discussed. Medical management is also discussed. Complications are also discussed.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This powerpoint describes the types of maxillectomy & operative steps for total maxillectomy. It also enumerates various flaps used for reconstruction of maxillectomy defect.
Detailed description of diagnosis and management of maxillofacial and neck space infections. Discussion of anatomy of the spaces is also done in details. Drainage of such spaces are also discussed. Medical management is also discussed. Complications are also discussed.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The inhibitory activity of L. crispatus against uropathogenes in vitroIJMCERJournal
ABSTRACT: Bacterial interference refers to the use of bacteria of virulence to compete with and protect against
colonization and infection by disease causing organisms. In this study, L. crispatus strain was used to detect its
antibacterial activity towered five species (one Gram-positive and four Gram-negative ) of the most common bacteria
causing urinary tract infection. L. crispatus completely inhibited growth of Staphylococcus aureus , while it had no
inhibitory effect on three of the other species.
Key Words: inhibitory activity, L. crispatus, uropathogens
ARTICLEdoi10.1038nature14098A new antibiotic kills pat.docxdavezstarr61655
ARTICLE
doi:10.1038/nature14098
A new antibiotic kills pathogens without
detectable resistance
Losee L. Ling1*, Tanja Schneider2,3*, Aaron J. Peoples1, Amy L. Spoering1, Ina Engels2,3, Brian P. Conlon4, Anna Mueller2,3,
Till F. Schäberle3,5, Dallas E. Hughes1, Slava Epstein6, Michael Jones7, Linos Lazarides7, Victoria A. Steadman7, Douglas R. Cohen1,
Cintia R. Felix1, K. Ashley Fetterman1, William P. Millett1, Anthony G. Nitti1, Ashley M. Zullo1, Chao Chen4 & Kim Lewis4
Antibiotic resistance is spreading faster than the introduction of new compounds into clinical practice, causing a public
health crisis. Most antibiotics were produced by screening soil microorganisms, but this limited resource of cultivable
bacteria was overmined by the 1960s. Synthetic approaches to produce antibiotics have been unable to replace this
platform. Uncultured bacteria make up approximately 99% of all species in external environments, and are an untapped
source of new antibiotics. We developed several methods to grow uncultured organisms by cultivation in situ or by using
specific growth factors. Here we report a new antibiotic that we term teixobactin, discovered in a screen of uncultured
bacteria. Teixobactin inhibits cell wall synthesis by binding to a highly conserved motif of lipid II (precursor of
peptidoglycan) and lipid III (precursor of cell wall teichoic acid). We did not obtain any mutants of Staphylococcus
aureus or Mycobacterium tuberculosis resistant to teixobactin. The properties of this compound suggest a path towards
developing antibiotics that are likely to avoid development of resistance.
Widespread introduction of antibiotics in the 1940s, beginning with
penicillin1,2 and streptomycin3, transformed medicine, providing effec-
tive cures for the most prevalent diseases of the time. Resistance develop-
ment limits the useful lifespan of antibiotics and results in the requirement
for a constant introduction of new compounds4,5. However, antimicro-
bial drug discovery is uniquely difficult6, primarily due to poor penetra-
tion of compounds into bacterial cells. Natural products evolved to breach
the penetration barriers of target bacteria, and most antibiotics intro-
duced into the clinic were discovered by screening cultivable soil micro-
organisms. Overmining of this limited resource by the 1960s brought
an end to the initial era of antibiotic discovery7. Synthetic approaches
were unable to replace natural products6.
Approximately 99% of all species in external environments are un-
cultured (do not grow under laboratory conditions), and are a prom-
ising source of new antibiotics8. We developed several methods to grow
uncultured organisms by cultivation in their natural environment9,10,
or by using specific growth factors such as iron-chelating siderophores11.
Uncultured organisms have recently been reported to produce interest-
ing compounds with new structures/modes of action—lassomycin, an
inhibitor of the essential mycobacterial protease.
Research by Mahendra Kumar Trivedi - Phenotypic and Biotypic Characterization...Abby Keif
Research on Trivedi Effect - we evaluated the effect of biofield treatment on phenotype and biotype characteristics of K. oxytoca (ATCC 43165). The study was performed into three groups i.e. C (control), T1 (treatment, revived), and T2 (treatment, lyophilized). Subsequently, groups T1 and T2 were received biofield treatment and control group was remained as untreated. Visit http://works.bepress.com/mahendra_trivedi/43/ for details.
Dr. Patrick Treacy discusses the origins of Dysport BTX-A. Used in the Europe/UK since 1991, Dysport is used in 76 other countries as well for both therapeutic use (such as movement disorders) and in 27 countries for aesthetic use, similar to Botox Cosmetic. In the United States, the safety of Dysport for the treatment of glabellar lines (frown lines) was studied in more than 2,400 patients. It is estimated that more than 600,000 patients in Europe have been treated over many years.
Abstract— After the II Word War, the chemical based industrial revolution generated a wide and global contamination due to the release in the environment of thousand of compounds without an adequate knowledge of their environmental biotransformation and their toxic effect on the living matter. Recently, it has been found that several of these compounds and/or their relative by-products are persistent environmental contaminants associated with undesirable long-term effects. At present many questions have to be clarified with particular reference to lipophilic polyhalogenated compounds, such as polychloro-dibenzo-dioxins (PCDD), polychloro-dibenzo-furans (PCDF) and polychloro-biphenyls (PCB). These compounds accumulate up the food chain and humans can reach relative high concentration in their body with a consequent risk for health. In this paper we discuss the some basic features of both biological and toxicological aspects related to the dioxins exposure.
Antibiotics
History and development of antibiotics
Decline of antibiotics
Bacteriophage: nature’s most abundant antibiotics
Phage specificity, resistance, transduction, lysis
Emergence of phages
Phage Case studies
Challenges to mainstream commercialization
Mycotoxins are recognized as toxic compounds of great concern in the context of human health and economy. Mycotoxins are toxic chemical products formed as secondary metabolites by some fungi that readily colonise crops in the field or after harvest. The toxicity syndrome resulting from the intake of such contaminated material by animal and manis termed Mycotoxicosis.These compounds pose a potential threat to human and animal health through ingestion of food products prepared from these commodities.Mycotoxicoses affect various systems of the body according to the target organs of the mycotoxin. This review revealed the major mycotoxins of fungal origin and their mycotoxicoses. The study also reviewed the history of mycotoxin, methods of mycotoxin detection, analysis and the health implications of consuming mycotoxin-contaminated foods/products. In most developing countries, majority are ignorant of the inherent dangers of consuming mouldy produce or food contaminated with fungi and moulds with possible contamination by mycotoxigenic fungi. In view of this, there is need for general and public education to sensitise the people on the health hazards posed by mycotoxins. Proper washing and cooking practices of food commodities, good agricultural practices, fast and effective analyses and detection, good produce handling and storage are some of the control/regulatory measures that should be encouraged, as to assist in mitigating the side effects of mycotoxins in food and health particularly in the tropical and sub-tropical countries and in African where there is enabling environment that promotes fungal growth.
International Organization of Scientific Research (IOSR)iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Similar to Clinical use of botulinum toxins in oral and maxillofacial surgery (20)
Supplemental corticosteroids for dental patients with adrenal insufficiencyR...DrKamini Dadsena
Primary Adrenal Insufficiency:
It is caused by a progressive destruction of the adrenal cortex, usually of an idiopathic nature (most commonly autoimmune), but also results from hemorrhage, sepsis, infectious diseases (such as tuberculosis, human immunodeficiency virus, cytomegalovirus and fungal infection), malignancy, adrenalectomy, amyloidosis or drugs.
Clinical assessment scoring system for tracheostomy (CASST) criterion: Objec...DrKamini Dadsena
Tracheotomy has been used for many centuries as a means to bypass upper airway obstruction.
Head and neck cancers are often associated with anatomic changes which can create a potentially difficult airway.
CARNOY’S SOLUTION AS A SURGICAL MEDICAMENT IN THETREATMENT OF KERATOCYSTIC O...DrKamini Dadsena
The term keratocyst was coined by Philipsen in 1956.
Unlike the other cystic lesion KOT, has got strong tendency for recurrence.
Treatment of these lesions remains controversial and has a number of dilemmas about the choice of treatment whether to use carnoys solution as an adjunct therapy after removal of the lesion.
Changing Guidelines of CPR & BLS For General Dental Practitioners & O...DrKamini Dadsena
The tolerance of the heart to anoxia is relatively high, but the central nervous system will show irreversible lesions if anoxia lasts for more than 3–4 min.
Though unusual, there are reports of deaths due to CPA in dental offices during dental treatment.
Cardiopulmonary resuscitation (CPR) is a vital skill which must be mastered by all health care professionals.
Therefore the thorough knowledge of CPR and Basic Life Support is of utmost importance to the dentist.
Neck Dissection: Nomenclature, Classification, and TechniqueDrKamini Dadsena
Removal of the at-risk lymphatic basins serves two important purposes.
First, it allows the removal and identification of occult metastasis in patients in whom cervical metastasis are a risk, - Elective neck dissection.
Secondly, it allows the removal of disease in patients in whom metastasis are highly suspected based on imaging, clinical examination or fine needle aspiration, - Therapeutic neck dissection.
Cavernous sinus thrombosis represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. The prompt recognition and management of this problem is critical.
In 1989, Shetty and Freymiller [7] reviewed indications for removal of teeth in the line of fracture. They recommended the following indications:
1. Significant periodontal disease with gross mobility and periapical pathology
2. Partially erupted third molars with pericoronitis or cystic areas
3. Teeth preventing the reduction of fractures
4. Teeth with fractured roots
5. Teeth with exposed root apices or teeth in which the entire root surface from the apex to the gingival margin is exposed
6. Excessive delay from the time of fracture to the time of definitive treatment
In addition to these indications, another indication that requires extraction of teeth in the line of fracture is an acute, recurring abscess at the site of the fracture despite antibiotic therapy(8)
Assessment of lingual nerve injury using different surgical variables for man...DrKamini Dadsena
Assessment of lingual nerve injury using different surgical variables for mandibular third molar surgery
The objective of this study was to investigate the incidence of sensory impairment of the lingual nerves following lower third molar surgery and to compare the outcome with various operative variables.
Factors that predicted lingual nerve injury were lingual flap retraction, tooth sectioning, and buccal guttering.
Instruments in major oral and maxillofacial surgeryDrKamini Dadsena
A surgical instrument is a specially designed tool or device for performing specific actions and carrying out desired effects during surgery or operations.
Fracture is a break in the structural continuity of bone, And starts immediately after the fracture occurs.
fracture results in a well-defined progression of tissue responses that are designed to remove tissue debris, to reestablish vascular supply and to produce a new skeletal matrix.
Traditional classification were given 100 years back when RTA , assaults, sports injuries, industrial accidents were minimal.
Over the past 100 years RTA (high speed & Low speed) assaults, sports injuries (high contact/ low contact), industrial accidents have increased.
Fracture patterns which are not matching the traditional injuries pattern.
Can speed up diagnosis and treatment planning
Cohorting / clubbing of complication to Specific Fractures.
It facilitate communication between peers and assist documentation and research.
It also have prognostic value for patients and assist Surgeons in planning their management.
It serves as a basis for treatment and for evaluation of the results.
Different fractures/ Areas of fracture has different treatment plan / approaches.
Undisplaced fracture : conservative/ surgical
Displaced Fractures: Surgical/ conservative with traction
Trauma is a global problem and continues to be a leading cause of disability and death.
Approximately 25% to 30% of deaths caused by trauma can be prevented when a systematic and organized approach is used.
The main goal of the initial assessment
Recognize the patient who does have life-threatening injuries
Establish treatment priorities, and
Manage them aggressively
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply or from a anastomised vessel.
Flaps come in many different shapes and forms. They range from simple advancements of skin to composites of many different types of tissue
The International Association for the Study of Pain (IASP)1 defines trigeminal neuralgia (TN) as a sudden, usually unilateral, severe brief stabbing recurrent pain in one or more branches of the fifth cranial nerve
synonyms
Idiopathic trigeminal neuralgia / Tic Doulourex.
Trifacial Neuralgia.
Fothergell’s disease.
In 1677 John Locke, a American physician and philosopher, accurately identified the major clinical features of TN
In 1756 the French physician Nicolaus Andre coined the term “Tic douloureux” to the condition.
The English physician John Fothergill in 1773 published detailed description of TN, since then, it has been referred to as ‘Fothergill’s disease’.
Peripheral injections
Long acting LA
Alcohol
Glycerol
Peripheral neurectomy/ nerve avulsion
Cryotherapy
Gasserian ganglion procedures
Percutaneous stereotactic radiofrequency thermal lesioning of the trigeminal ganglion and/or root (rfl)
percutaneous glycerol gangliolysis of the trigeminal ganglion
percutaneous balloon microcompression of the trigeminal ganglion
Intracranial procedures
MVD
Partial sensory rhizotomy
Gamma knife radiation to the trigeminal root entry zone GKR
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
The practice of surgery rests on certain fundamental principles which remain unchanged, though to apply them the surgeon may have to modify techniques to suit the anatomical field, the type of operation and the conditions obtaining at the time.
Obstructive sleep apnea (OSA) is a prevalent chronic disease characterized by pharyngeal collapse during sleep.
Sleep disorder that involves cessation or significant decrease in airflow through the upper airway in the presence of breathing effort.
Obstructive sleep apnea is the second most common sleep disorder, insomnia being the most common.
Associated with recurrent oxyhemoglobin desaturations and arousals from sleep
Apnea index- no. of apneas /hr of total sleep time.
AHI (APNEA-HYPOPNEA INDEX)- No of apneas and hypoapneas/hr of total sleep time.
RDI (Respiratory Disturbance Index) – no. of apneas, hypoapneas and respiratory effort related arousals(RERA)/hr of total sleep time.
Pain pathway gate control theory
Pain management
An unpleasant emotional experience usually initiated by noxious stimulus and transmitted over a specialized neural network to CNS where it is interpreted as such.
1. Exteroceptors: arising from receptors from skin & mucosa. sensed at conscious level
E.g. Merkel corpuscles : Tactile receptors.
Free Nerve ending :Perceive superficial pain.
2. Proprioceptors : From musculoskeletal structures.
The presence , positions & movement of body. below conscious levels.
E.g. 1) Muscle spindles : Skeletal muscle fibers. Mechanoreceptors.
2) Free nerve ending : Perceive deep somatic pain & other sensations.
3. Interoceptors : From viscera of body below conscious level.
E.g. Pacinian corpuscles : perception of touch-pressure.
Free nerve ending : Perceive visceral pain & other sensations.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
3. CLINICAL USE OF
BOTULINUM TOXINS IN
ORAL AND
MAXILLOFACIAL
SURGERY
O.W. Majid ,
Department of Oral and Maxillofacial
Surgery, College of Dentistry, University
of Mosul, Mosul, Iraq
Int. J. Oral Maxillofac. Surg. 2010; 39: 197–207
4. OUTLINE
1. Introduction
2. History
3. Bacteriology
4. Structure and Toxicity
5. Mechanism of action
6. Preparations
7. Cosmetic use
8. Therapeutic use
9. Complications
10. References
5. INTRODUCTION
Purified botulinum toxin (BTX) was the first bacterial toxin
used as a medicine. Since its introduction into clinical use,
over 30 years ago, it has become a versatile drug in various
fields of medicine.
Its mechanism of inhibiting acetylcholine release at
neuromuscular junctions following local injection is unique for
the treatment of facial wrinkles.
Other dose-dependent anti-neuroinflammatory effects and
vascular modulating properties have extended its spectrum of
applications.
6. HISTORY
The idea of a possible therapeutic use for botulinum toxin (BTX)
was first developed by the German physician and poet Justinus
Kerner (1786–1862); he called it ‘sausage poison
In 1897, Emile van Ermengem investigated an epidemic of botulism
in Ellezelles, Belgium, after the consumption of raw ham. He
isolated the bacteria from the ham and produced the disease in
laboratory animals by injecting the toxin produced by the
organism.
• Erbguth FJ, Naumann M. Historical aspects of botulinum toxin: Justinus Kerner (1786–1862) and the
‘‘sausage poison’’. Neurology 1999: 53: 1850–1853.
• Cherington M. Botulism: update and review. Semin Neurol 2004: 24: 155–163.
7. HISTORY
Dembek ZF in 2007, BTX was developed as a biological weapon
by many countries in the twentieth century*.
H. Vargas in 2000, Many countries stopped research related to
biological weaponry after signing the Biological and Toxin
Weapons Convention, purification of BTX for medical use
continued**.
A therapeutic use for botulinum toxin type-A (BTX-A) was first
studied in primates by Scott et al in 1973***. In the late 1970s, the
toxin was introduced as a therapeutic agent for the treatment of
strabismus****.
• *Dembek ZF, Smith LA, Rusnak JM. Botulinum Toxin (chapter 16). In: Dembek ZF, ed: Medical Aspects of Biological
Warfare. Virginia: Office of TheSurgeon General 2007: 337–353.
• ** H. Vargas, L.T. Galatti, S.M. Parnes A pilot study evaluationing the treatment of postparotidectomy sialoceles
with botulinum toxin type A Arch Otolaryngol Head Neck Surg, 126 (2000), pp. 421–424
• *** A.B. Scott Botulinum toxin injection of eye muscles to correct strabismus Trans Am Ophthalmol Soc, 79 (1981),
pp. 734–770
• **** A.B. Scott, A. Rosenbaum, C.C. Collins Pharmacologic weakening of extraocular muscles Invest Ophthalmol,
12 (1973), pp. 924–927
8. HISTORY
Niamtu in 2003, BTX was first used for treating facial wrinkles and
aging skin in 1988, but its widespread cosmetic use did not occur
until the mid-1990s*.
There was much speculation about the storage, dilution, delivery
methods and treatment doses. In maxillofacial surgical practice,
Niamtu reported on the cosmetic use of BTX for facial rhytids and
dynamic lines in 1999 and 2000** , ***.
During the mid- and late-1990s, BTX was used for lateral canthal
lines (crow's feet), platysmal banding, orbicularis oris injection,
masseter muscle injection and the treatment of
temporomandibular disorders (TMDs).
* J. Niamtu Botulinum Toxin A: A Review of 1,085 Oral and Maxillofacial Patient Treatments J Ora Maxillofac Surg, 61
(2003), pp. 317–324
** J. Niamtu Aesthetic uses of botulinum toxin A J Oral Maxillofac Surg, 57 (1999), pp. 1228–1233
*** J. Niamtu Cosmetic facial surgery Oral Maxillofac Surg Clin North Am, 12 (2000), p. 595
9. BACTERIOLOGY
L.D.S. Smith in 1978, Clostridium species bacteria are
sporulating, obligate anaerobic, Gram-positive bacilli.
The spores of C. botulinum are ubiquitous, distributed
widely in soil and marine sediments worldwide and
often found in the intestinal tract of domestic grazing
animals * , **.
J. Sobel etal in 2004, Under appropriate environmental
or laboratory conditions, spores can germinate into
vegetative cells that will produce toxin. C. botulinum
grows and produces neurotoxin in the anaerobic
conditions frequently encountered in the canning or
preservation of foods *** , ****.
• * L.D.S. Smith The occurrence of Clostridium botulinum and Clostridium tetani in the soil of the United States Health Lab Sci.,
15 (1978), pp. 74–80
• ** H. Sugiyama Clostridium botulinum neurotoxin Microbiol Rev., 44 (1980), pp. 419–448
• *** J. Sobel, N. Tucker, A. Sulka Foodborne botulism in the United States, 1900–2000 Emerg Infect Dis., 10 (2004), pp. 1606–1611
• *** J.K. Varma, G. KatsitadzenMoiscrafishvili. Signs and symptoms predictive of death in patients with foodborne botulism—
Republic of Georgia, 1980–2002 Clin Infect Dis., 39 (2004), pp. 357–362
10. BACTERIOLOGY
W. Huang etal in 2000 and P.T. Ting in 2004 reported Seven
different strains of Clostridium have been described
(designated A, B, C (1 and 2), D, E, F and G), and each
produces a distinct neurotoxin identified by the corresponding
letter of the bacterial strain producing it, so, there are 7 distinct
neurotoxins (BTX-A, -B, -C, -D, -E, -F, -G)
W. Huang in 2000 and T.C. Flynn in 2006 Humans can be
affected by the toxins of 5 strains (A, B, E, F and G) and are not
affected by the toxins of strains C and D .
J.L. Middlebrook in 1997 reported All 7 toxins may
potentially cause botulism in humans given a high enough
exposure.
• T.C. Flynn Update on botulinum toxin Semin Cutan Med Surg, 25 (2006), pp. 115–121
• W. Huang, J.A. Foster, A.S. RogachefskybPharmacology of botulinum toxin J Am Acad Dermatol, 43 (2 Pt 1) (2000), pp. 249–259
• P.T. Ting, A. Freiman The story of Clostridium botulinum: From food poisoning to BOTOX Clin Med, 4 (2004), pp. 258–261
• J.L. Halpern, L.A. Smith, K.B. Seamon, K.A. Groover, W.H. HabigSequence homology between tetanus and botulinum toxins detected by an antipeptide
antibody Infect Immun., 57 (1989), pp. 18–22
• C.L. Hatheway Clostridium botulinum and other clostridia that produce botulinum neurotoxins A.H.W. Hauschild, K.L. Dodds (Eds.), Clostridium
botulinum—Ecology and Control in Foods, Marcel Dekker, Inc, New York, NY (1992), pp. 3–10
• D.R. Franz Botulinum toxins F.R. Sidell, E.T. Takafuji, D.R. Franz (Eds.), Textbook of Military Medicine, Part I: Warfare, Weaponry, and the asualty—
Medical Aspects of Chemical and Biological Warfare, Department of the Army, Office of The Surgeon General, Borden Institute, Washington, DC (1997),
11. BACTERIOLOGY
J.L. Halpern in 1989 reported that There is some serum
cross-reactivity among the serotypes because they share some
sequence homology with one another as well as with tetanus
toxin.
C.L. Hatheway in 1992 reported All 7 neurotoxins are
structurally similar but immunologically distinct.
• J.L. Halpern, L.A. Smith, K.B. Seamon, K.A. Groover, W.H. Habig Sequence homology between tetanus and botulinum toxins
detected by an antipeptide antibody Infect Immun., 57 (1989), pp. 18–22
• C.L. Hatheway Clostridium botulinum and other clostridia that produce botulinum neurotoxins A.H.W. Hauschild, K.L. Dodds
(Eds.), Clostridium botulinum—Ecology and Control in Foods, Marcel Dekker, Inc, New York, NY (1992), pp. 3–10
12. STRUCTURE AND TOXICITY
W. Huang in 2000 Toxins produced by clostridial bacteria
are high-molecular-weight protein complexes that include
3 key proteins:
i. A 150-kda toxin,
ii. A non-toxin hemagglutinin protein, and
iii. A non-toxin non-hemagglutinin protein.
The 150-kDa toxin is composed of a 100-kDa heavy chain
and a 50-kDa light chain. Disulfide and noncovalent bonds
link the heavy and light chains, and both chains are
required for neurotoxicity.
W. Huang, J.A. Foster, A.S. Rogachefsky Pharmacology of botulinum toxin J Am Acad Dermatol, 43 (2 Pt 1) (2000), pp.
249–259
13. STRUCTURE AND TOXICITY
B.A. Herrero in 1967 based on animal studies, estimated human
LD50 is approximately 0.09–0.15 μg by intravenous administration,
D.R. Franz in 1993 reported 0.7–0.9 μg by inhalation and 70 μg by
oral administration.
A.B. Scott in 1988 Based on findings from primate studies, human
LD50 for intramuscular BTX injection is estimated at 2500–3000 U
for a 70-kg adult (35–40 U/kg).
A. Carruthers in 2001 reported that BTX is the most toxic material
known. It is 4 times more lethal in mice than tetanus toxin, 1 × 1010
more lethal than curare, and 100 × 1010 more lethal than sodium
cyanide.
• A. Carruthers, J. Carruthers Botulinum toxin type A: History and current cosmetic use in the upper face Semin Cutan Med Surg, 20 (2001),
pp. 71–84
• D.R. Franz, etal Efficacy of prophylactic and therapeutic administration of antitoxin for inhalation botulism B.R. DasGupta (Ed.), Botulinum
and Tetanus Neurotoxins: Neurotransmission and Biomedical Aspects, Plenum Press, New York, NY (1993), pp. 473–476
• A.E. Ecklung, etal Experimental botulism in monkeys—Aclinical pathological study Exp Mol Pathol., 6 (1967), pp. 84–95
• E.J. Schantz, etal Properties and use of botulinum toxin and other microbial neurotoxins in medicine Microbiol Rev., 56 (1992), pp. 80–99
• A.B. Scott etal Systemic toxicity of botulinum toxin by intramuscular injection in the monkey Mov Disord., 3 (1988), pp. 333–335
14. MECHANISM OF ACTION
M.F. Brin in 2000, BTX is a protease that causes temporary chemical
denervation of skeletal muscle by blocking the Ca+2-mediated
release of acetylcholine from nerve endings of alpha and gamma
motor neurons (myoneural junction), producing a transient dose-
dependent weakening of the muscle activity rendering it
nonfunctional without systemic effects.
A. Blitzer in 2001, This inhibition of muscular contraction is believed
to be followed by the sprouting of new axon terminals, which results
in synaptic regeneration and the reestablishment of neuromuscular
transmission.
• M.F. Brin Botulinum toxin therapy: basic science and overview of other therapeutic applications A. Blitzer (Ed.),
Management of facial lines and wrinkles, Lippincott, Williams and Wilkins, Philadelphia (2000 p), pp. 279–302
• A. Blitzer, L. Sulica Botulinum toxin: basic science and clinical uses in otolaryngology Laryngoscope, 111 (2001), pp. 218–226
15. MECHANISM OF ACTION
J. O’day in 2001 The area of flaccidity produced may be larger than
the area of muscle denervated. Weakening of surrounding
muscles not injected may also occur because of toxin diffusion.
C.M. Shaari in 1991 reported based on Animal studies that BTX-A
diffuses across fascial planes to surrounding muscles.
N.S. Sadick in 2004 reported Clinical effect occurs within
approximately 3–7 after administration, followed by 1–2 weeks of
maximum effect and full nerve recovery within 3–6 months
(approximately 3 months).
• C.M. Shaari Quantifying the spread of botulinum toxin through muscle fascia Laryngoscope, 101 (1991), pp. 960–
963
• J. O’day Use of botulinum toxin in neuro-ophthalmology Curr Opin Opthalmol, 12 (2001), pp. 419–422
• N.S. Sadick, S.L. Matarasso Comparison of botulinum toxins A and B in the treatment of facial rhytides Dermatol
Clin, 22 (2004), pp. 221–226
17. BTX-A
Botox (Allergan Inc, USA): BTX-A was first used in humans in 1968
to treat strabismus by A.B. Scott.
It is specifically approved for the therapeutic treatment of
strabismus, blepharospasm, cervical dystonia and axillary
hyperhidrosis.
Each vial of Botox contains 5 ng (100 U) of air-dried toxin. Each vial
contains 500 μg of albumin and 900 μg of sodium chloride.
• A.B. Scott, A. Rosenbaum, C.C. Collins Pharmacologic weakening of extraocular muscles Invest Ophthalmol, 12 (1973), pp. 924–927
• J. Carruthers, etal The evolution of botulinum neurotoxin type A for cosmetic applications J Cosmet Laser Ther, 9 (2007), pp. 186–193
• J.A. Carruthers etal A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type
A in the treatment of glabellar lines J Am Acad Dermatol, 46 (2002), pp. 840–849
• S.J. Carruthers etal Consensus recommendations on the use of botulinum toxin type A in facial aesthetics Plast Reconstr Surg, 114 (6
Suppl) (2004), pp. 1S–22S
• S. Fagien, etalPatient-reported outcomes with botulinum toxin type A treatment of glabellar rhytids: A double-blind, randomized,
placebo-controlled study Dermatol Surg, 33 (1 Spec No.) (2007), pp. S2–S9
• M. Hallett One man's poison—Clinical applications of botulinum toxin N Engl J Med, 341 (1999), pp. 118–120
• N.J. Lowe etal Botulinum A exotoxin for glabellar folds: A double-blind, placebo-controlled study with an electromyographic injection
technique J Am Acad Dermatol, 35 (1996), pp. 569–572
• P. Lowe, etal Comparison of two formulations of botulinum toxin type A for the treatment of glabellar lines: A double-blind, randomized
study J Am Acad Dermatol, 55 (2006), pp. 975–980
• P.L. Lowe, etal A comparison of two botulinum type A toxin preparations for the treatment of glabellar lines: Double-blind, randomized,
pilot study Dermatol Surg, 31 (2005), pp. 1651–1654
18. BTX-A
Dysport (Ipsen Limited, UK) is another BTX-A product approved
for cosmetic use.
Each vial contains 12.5 ng (500 U) of air-dried toxin, 125 μg of
albumin, and 2.5 mg of lactose. Dysport comes from a different
type A strain of bacteria than Botox and doses are not equivalent.
Direct comparisons of Botox and Dysport in animal studies
suggest that the equivalence doses are 1 U Botox to 2.5–5 U
Dysport.
S.L. Matarasso Comparison of botulinum toxin types A and B: A bilateral and double-blind randomized evaluation in the
treatment of canthal rhytides Dermatol Surg, 29 (2003), pp. 7–13
19. BTX-A
Xeomin (NT-201; Merz Pharmaceuticals GmBH, Germany) F.
Mancini in 2003, packaged as a freeze-dried powder, is a purified
BTX-A that is free of the accessory complexing proteins
(hemagglutinin and nonhemagglutinin) found in the other BTX-A
products.
Jost in 2007 reported that xeomin is less immunogenic than
other BTX-A products.
S.R. Freeman in 2008 found that it useful when large amounts of
toxin are required for extended periods.
F. Mancini, etal Double-blind, placebo-controlled study to evaluate the efficacy and safety of botulinum toxin type A in the
treatment of drooling in parkinsonism Mov Disord, 18 (2003), pp. 685–688
Jost Wh etal Botulinum neurotoxin type A free of complexing proteins (XEOMIN) in focal dystonia Drugs, 67 (2007),
pp. 669–683
S.R. Freeman, J.L. Cohen New Neurotoxins on the Horizon Aesthetic Surg J, 28 (2008), pp. 325–330
20. BTX-A
K. Wohlfarth etal in 2007 and Dressler D etal in 2008 found that
Botox and Xeomin have similar dose-dependent paralytic effects
and minimal diffusion effects on surrounding musculature and . It
has been suggested that conversion of Botox and Xeomin doses
can be performed in a 1:1 ratio allowing exchange of both BTX
drugs in a therapeutic setting.
• Dressler D, Mander GJ, Fink K. Equivalent potency of Xeomin and BOTOX. Abstracts Toxins 2008/Toxicon 51: 10.
• K. Wohlfarth, etal Neurophysiological double-blind trial of a botulinum neurotoxin type a free of complexing proteins Clin
Neuropharmacol, 30 (2007), pp. 86–94
21. BTX-A
Prosigne (Lanzhou Biological Products Institute, China) X. Tang in
2000, it has been available for clinical use there since October
1993.
C.R. Rieder in 2007, Preliminary studies suggest that Prosigne may
have therapeutic actions comparable with Botox for some
therapeutic purposes.
PurTox (Mentor Corp, Santa Barbara, CA, USA) S.R. Freeman in
2008 is a purified BTX-A that is undergoing trials to approve its
efficacy in some therapeutic uses.
• C.R. Rieder, etal A double-blind, randomized, crossover study of prosigne versus botox in patients with blepharospasm and
hemifacial spasm Clin Neuropharmacol, 30 (2007), pp. 39–42
• X. Tang, X. Wan Comparison of Botox with a Chinese type A botulinum toxin Chin Med J (Engl), 113 (2000), pp. 794–
798
• S.R. Freeman, J.L. Cohen New Neurotoxins on the Horizon Aesthetic Surg J, 28 (2008), pp. 325–330
22. BTX-B
Myobloc (Solstice Pharmaceuticals, South San Francisco, CA, USA)
A.L. Ramirez in 2002 has shown efficacy in clinical trials for the
treatment of various movement disorders since 1995 and was
approved by the FDA for the treatment of cervical dystonia and
hemifacial spasm in 2001163.
M.F. Lew in 2000, T. Alster and L. Baumann in 2003 ,its efficacy in the
treatment of lateral canthal, glabellar and forehead rhytides. It
appears to offer versatility in cosmetic neuroblockade by exhibiting
action in patients resistant to BTX-A products
• A.L. Ramirez etal Botulinum toxin type B (MyoBloc) in the management of hyperkinetic facial lines Otolaryngol Head Neck Surg, 126 (2002), pp. 459–
467
• T. Alster, etal Botulinum toxin type B for dynamic glabellar rhytides refractory to botulinum toxin type A Dermatol Surg, 29 (2003), pp. 516–518
• L. Baumann, etal A double-blinded, randomized, placebo-controlled pilot study of the safety and efficacy of Myobloc (botulinum toxin type B)-
purified neurotoxin complex for the treatment of crow's feet: A double-blinded, placebo- controlled trial Dermatol Surg, 29 (2003), pp. 508–515
• M.F. Lew, etal The safety and efficacy of botulinum toxin type B in the treatment of patients with cervical dystonia: Summary of three controlled
clinical trials Neurology, 55 (12 Suppl 5) (2000), pp. S29–S35
• N.J. Lowe, etal Botulinum toxins types A and B for brow furrows: Preliminary experiences with type B toxin dosing J Cosmet Laser Ther, 4 (2002), pp.
15–18
• S.L. Matarasso Comparison of botulinum toxin types A and B: A bilateral and double-blind randomized evaluation in the treatment of canthal
rhytides Dermatol Surg, 29 (2003), pp. 7–13
• N. Sadick Prospective open-label study of botulinum toxin type B (Myobloc) at doses of 2,400 and 3,000 U for the treatment of glabellar wrinkles
Dermatol Surg, 29 (2003), pp. 501–507
• N.S. Sadick Botulinum toxin type B for glabellar wrinkles: A prospective open-label response study Dermatol Surg, 28 (2002), pp. 817–821
• N.S. Sadick etal Comparison of botulinum toxins A and B in the treatment of facial rhytides Dermatol Clin, 22 (2004), pp. 221–226
23. BTX-B
S.L. Matarasso in 2003, Myobloc is preconstituted in vials containing
25 ng (2500 U)/0.5 cc, 50 ng (5000 U)/1.0 cc and 100 ng (10,000
U)/2.0 cc of product in solution with 0.05% albumin.
S.R. Freeman in 2008, Treatment of patients with cervical dystonia
with Botox and Myobloc led to attempts at equivalency doses in
many cosmetic studies (1 U Botox equals approximately 50–100 U
Myobloc)
• S.L. Matarasso Comparison of botulinum toxin types A and B: A bilateral and double-blind randomized evaluation in the
treatment of canthal rhytides Dermatol Surg, 29 (2003), pp. 7–13
• S.R. Freeman, J.L. Cohen New Neurotoxins on the Horizon Aesthetic Surg J, 28 (2008), pp. 325–330
24. BTX-B
T.C. Flynn in 2003 & 2004, N.J. Lowe in 2002, S.L. Matarasso in 2003
and A.L. Ramirez in 2002 reported based on Studies comparing the
cosmetic efficacies of BTX-A and BTX-B that the latter causes more pain
during injection, has shorter action and probably a less predictable
diffusion pattern.
S.R. Freeman in 2008 reported that BTX-B could be useful in situations
in which rapid onset is desirable or in which there are concerns about
antibody production to BTX-A.
• T.C. Flynn Myobloc Dermatol Clin, 22 (2004), pp. 207–211
• T.C. Flynn, R.E. Clark Botulinum toxin type B (MYOBLOC) versus botulinum toxin type A (BOTOX) frontalis study: rate of onset
and radius of diffusion Dermatol Surg, 29 (2003), pp. 519–522
• N.J. Lowe, P.S. Yamauchi, G.P. Lask, R. Patnaik, D. Moore Botulinum toxins types A and B for brow furrows: Preliminary
experiences with type B toxin dosing J Cosmet Laser Ther, 4 (2002), pp. 15–18
• S.L. Matarasso Comparison of botulinum toxin types A and B: A bilateral and double-blind randomized evaluation in the
treatment of canthal rhytides Dermatol Surg, 29 (2003), pp. 7–13
• A.L. Ramirez, J. Reeck, C.S. Maas Botulinum toxin type B (MyoBloc) in the management of hyperkinetic facial lines
Otolaryngol Head Neck Surg, 126 (2002), pp. 459–467
• S.R. Freeman, J.L. Cohen New Neurotoxins on the Horizon Aesthetic Surg J, 28 (2008), pp. 325–330
25. COSMETIC USES
Intramuscular injection of BTX to reduce facial wrinkles is the most
common cosmetic procedure performed in many countries. In
conjunction with fillers, BTXs allow the practitioner to sculpt the face
through alterations in the dynamics of the facial muscles. The limited
on-label uses of these drugs for hyperkinetic forehead wrinkles and
brow furrows belie its range of cosmetic applications.
26. FACIAL WRINKLES
J. Niamtu in 1999 S. Fagien in 2001 and J.E. Frampton in 2003 The
cosmetic potential of BTX-A was first explored in the mid 1980s in
the treatment of hyperfunctional facial lines. Since then, BTX-A has
been used to temporarily treat glabellar lines and other
hyperfunctional facial lines such as horizontal forehead lines, lateral
canthal lines ‘crow's feet’, platysma bands and perioral lines.
S. Fagien, F.S. Brandt Primary and adjunctive use of botulinum toxin type A (Botox) in facial aesthetic surgery: beyond the glabella
Clin Plast Surg, 28 (2001), pp. 127–148
J.E. Frampton, S.E. Easthope Botulinum toxin A (Botox cosmetic): a review of its use in the treatment of glabellar frown lines Am J
Clin Dermatol, 4 (2003), pp. 709–725
J. Niamtu Aesthetic uses of botulinum toxin A J Oral Maxillofac Surg, 57 (1999), pp. 1228–1233
27. FACIAL WRINKLES
J. Carruthers in 1992, Multiple injection techniques have been
described. Some authors describe a method based on brow
position.
J. Niamtu in 1999, 2000 and 2003 describe a method based on needle
angulation and measurement and All injections are now made
perpendicular to the skin surface and are tailored to the specific
anatomy, but they must be 10 mm away from the bony orbit
because the apparent diffusion of BTA is approximately 10 mm.
• J. Carruthers, A. Carruthers Treatment of glabellar frown lines with C. botulinum-A exotoxin J Dermatol Surg Oncol, 18
(1992), pp. 17–21
• J. Niamtu Aesthetic uses of botulinum toxin A J Oral Maxillofac Surg, 57 (1999), pp. 1228–1233
• J. Niamtu Botulinum Toxin A: A Review of 1,085 Oral and Maxillofacial Patient Treatments J Oral Maxillofac Surg, 61 (2003), pp.
317–324
• J. Niamtu Cosmetic facial surgery Oral Maxillofac Surg Clin North Am, 12 (2000), p. 595
28. MASSETERIC & TEMPORALIS MUSCLE
HYPERTROPHY
M. Metai in1994, B.A. Rijsdijk in 1998 and B. Bentsianov, etal in 2004
The early results of treatment with intramasseter injections of BTX
have been encouraging and satisfying to patients, but the effect
has not been well quantified.
A.M. Isaac in 2000, Temporalis muscle hypertrophy is less common
but has been managed successfully using BTX injection; there were
no appreciable side effects
• B. Bentsianov, etal Botulinum toxin treatment of temporomandibular disorders, masseteric hypertrophy, and cosmetic masseter reduction
Oper Tech Otolaryngol Head Neck Surg, 15 (2004), pp. 110–113
• M. Metai Morphological and functional-changes in masseter after administration of botulinum toxin for treatment of masseteric hypertrophy
J Dent Res, 75 (1996 May), p. 1164 A.P. Moore, etal The Medical Management of Masseteric Hypertrophy With Botulinum Toxin Type A Br J
Oral Maxillofac Surg, 32 (1994), pp. 26–28
• B.A. Rijsdijk Botulinum toxin Type A treatment of cosmetically disturbing masseteric hypertrophy (DUT) Ned Tijdschr Geneeskd, 142 (1998),
pp. 529–532
• A.M. Isaac Unilateral temporalis muscle hypertrophy managed with botulinum toxin type A Br J Oral Maxillofac Surg, 38 (2000), pp. 571–572
29. THERAPEUTIC USES
B. Freund, etal in 2000, D.D. Truong in2006, BTX has evolved from a
poison to a versatile clinical tool in conditions resulting from
muscular hyperfunction, includes focal dystonias, vocal tics and
stuttering, cricopharyngeal achalasia, various manifestations of
tremor, hemifacial spasm, temporomandibular joint dysfunction,
bruxism, masticatory myalgias, sialorrhea, hyperhidrosis and
headache.
K.A. Stefan in 2004, BTX used in dental implantology for the
prophylactic reduction of masseter and temporalis muscle strength
after implantation in immediate load protocols.
• B. Freund, etal Botulinum toxin: new treatment for temporomandibular disorders Br J Oral and Maxillofac Surg, 38 (2000), pp.
466–471
• D.D. Truong, W.H. Jost Botulinum toxin: Clinical use (Review) Parkinsonism and Related Disorders, 12 (2006), pp. 331–355
• K.A. Stefan, etal The therapeutic use of botulinum toxin in cervical and maxillofacial conditions: an evidence-based review Oral Surg Oral Med
Oral Pathol Oral Radiol Endod, 104 (2007), pp. e1–e11
30. TEMPOROMANDIBULAR JOINT (TMJ)
B. Freund, etal in 1999, B.J. Freund, etal in2002, The injection of BTX-A
into the masseter and temporalis muscles of patients with TMD
reduced subjective pain and tenderness
P.C. Song, etal in 2007, This was attributed to the presumed action of
BTX on nociceptors and P.L. Durham etal in 2004, the inhibitory effect
of specific protein-receptor binding within the intracellular
compartment on the release of neuropeptides and inflammatory
molecules, such as calcitonin gene-related peptide, substance P, and
glutamate
S. Arnaud, etal in 2006, Most patients with restricted mouth opening
experienced some degree of improvement in the maximal range of
vertical motion after BTX therapy. Muscular relaxation, reduction of
inflammation in the muscle and the TMJ, and the guarding response
to pain may contribute to this finding
• B. Freund, etal The Use of Botulinum Toxin for the Treatment of Temporomandibular Disorders: Preliminary Findings J Oral Maxillofac Surg, 57 (1999), pp. 916–920
• B.J. Freund, etal Relief of tension-type headache symptoms in subjects with temporomandibular disorders treated with botulinum toxin-A
Headache, 42 (2002), pp. 1033–1037
• P.C. Song, etal The emerging role of botulinum toxin in the treatment of temporomandibular disorders Oral Dis, 13 (2007), pp. 253–260
• P.L. Durham etal Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for
migraine therapy Headache, 44 (2004), pp. 35–42
• S. Arnaud, etal Nonsurgical management of traumatic injuries of the parotid gland and duct using type A botulinum toxin Plast Reconstr Surg, 117
31. TEMPOROMANDIBULAR JOINT (TMJ)
M.F. Brin, etal in1987, B. Daelen etal in1997 and M. Bakke, etal in
2005, BTX injection into the lateral pterygoid muscle has reduced
the clicking associated with TMD. Clicking was permanently
eliminated in some cases with a small but distinctive positional
improvement in the disc–condyle relationship.
C.B. Ivanhoe, etal in 1997 and Several studies have described the
treatment of bruxism with BTX. Some authors have found that BTX-
A injection into the flexor muscles of the mandible produced
subjective and objective reductions in the power of muscular
voluntary contraction in most subjects.
B. Freund in 2003, Intramuscular injection of BTX as an adjunct to
arthrocentesis of the TMJ gave encouraging results regarding
duration of improvement. 78
M. Bakke, etal Treatment of severe temporomandibular joint clicking with botulinum toxin in the lateral pterygoid muscle in two cases of anterior disc displacement Oral
Surg Oral Med Oral Pathol Oral Radiol Endod, 100 (2005), pp. 693–700
M.F. Brin, etal Localized injections of botulinum toxin for the treatment of focal dystonias and hemifacial spasm Mov Disord, 2 (1987), pp. 237–254
B. Daelen etal Treatment of recurrent dislocation of the temporomandibular joint with type A botulinum toxin Int J Oral Maxillofac Surg, 26 (1997), pp.
458–460
C.B. Ivanhoe, etal Bruxism after brain injury: successful treatment with botulinum toxin- A Arch Phys Med Rehabil, 78 (1997), pp. 1272–1273
B. Freund, M. Schwartz Intramuscular injection of botulinum toxin as an adjunct to arthrocentesis of the temporomandibular joint: preliminary
observations Br J Oral Maxillofac Surg, 41 (2003), pp. 351–352
32. TEMPOROMANDIBULAR JOINT (TMJ)
D.M. Pérez etal in 2004, BTX-A was first used to treat surgical failures
and then used as initial treatment. Treating only the lateral pterygoid
muscle appears to be sufficient to prevent temporarily recurrent
dislocation
B. Daelen etal in1997 and D.M. Pérez etal in 2004, BTX injection
therapy is also an option in patients who suffer recurrent dislocation
of the TMJ as a result of impaired muscle coordination secondary to
oromandibular dystonia, neuroleptically induced early and late
dyskinesias, epilepsy and brain-stem syndromes.
D.M. Pérez, P.G. Espiga Recurrent Temporomandibular Joint Dislocation Treated With Botulinum Toxin: Report of 3 Cases J Oral Maxillofac Surg, 62 (2004), pp. 244–246
B. Daelen etal Treatment of recurrent dislocation of the temporomandibular joint with type A botulinum toxin Int J Oral Maxillofac Surg, 26 (1997), pp.
458–460
33. SALIVARY SECRETORY DISORDERS
K.O. Bushara in 1997 and R. Giess in 2000 Topical injection of BTX-A
as a minimally invasive option for the treatment of drooling has
been used for many years in neurological diseases.
P. Capaccio etalin 2008 Its greatest limitation in this indication is its
transient effectiveness (3–4 months), requiring multiple and
expensive administrations.
M. Ellies in 2000 and 2003 The therapeutic effect is based on the
inhibitory action of the toxin at the cholinergic receptors of the
salivary gland cells, shown in animal experiments.
• K.O. Bushara Sialorrhea in amyotrophic lateral sclerosis: a hypothesis of a new treatment-botulinum toxin A injections of the parotid glandsMed Hypotheses, 48
(1997), pp. 337–339
• R. Giess, M. Naumann, E. Werner Injections of botulinum toxin A into the salivary glands improve sialorrhoea in amyotrophic lateral sclerosis J
Neurol Neurosurg Psychiatry, 69 (2000), pp. 121–123
• P. Capaccio etal Botulinum toxin therapy: a tempting tool in the management of salivary secretory disorders Am J Otol – Head and Neck
Medicine and Surgery, 29 (2008), pp. 333–338
• M. Ellies, R. Laskawi, S. Rohrbach-Volland, C. Arglebe Up-todate report of botulinum toxin therapy in patients with drooling caused by different
etiologies J Oral Maxillofac Surg, 61 (2003), pp. 454–457
• M. Ellies, R. Laskawi, G. Tormahlen The effect of local injection of botulinum toxin A on the parotid gland of the rat: An immunohistochemical
and morphometric study J Oral Maxillofac Surg, 58 (2000), pp. 1251–1256
34. SALIVARY SECRETORY DISORDERS
BTX has found application for sialorrhea in Parkinson's disease by G.
Lagalla, etal in 2006, amyotrophic lateral sclerosis by R. Giess, etal in 2000,
cerebral palsy and carcinoma of the upper digestive tract by M. Porta,
etal in 2001.
C. Drobik in 1995, Capaccio etal in 2008 BTX has also been used
successfully to treat auriculotemporal (Frey's) syndrome P. Drummond in
2002, it reduces the skin area affected by gustatory sweating by
inhibiting the sweat glands abnormally re-innervated by the cholinergic
pathway.
M. Ellies in 2003 BTX-A also has advantages in temporarily drooling
states because its effect is only temporary. P. Capaccio etal in 2008 In
patients with recurrent and chronic parotitis, BTX injection resulted in a
reduction in the number of episodes of parotid swelling.
G. Lagalla, etal Botulinum toxin type A for drooling in Parkinson's disease: a double-blind, randomized, placebo-controlled study Mov Disord, 21 (2006), pp. 121–125
R. Giess, etal Injections of botulinum toxin A into the salivary glands improve sialorrhoea in amyotrophic lateral sclerosis J Neurol Neurosurg Psychiatry, 69
(2000), pp. 121–123
M. Porta, etal Treatment of sialorrhea with ultrasound guided botulinum toxin type A injections in patients with neurological disorders J Neurol Neurosurg
Psychiatry, 70 (2001), pp. 538–540
P. Capaccio etal Botulinum toxin therapy: a tempting tool in the management of salivary secretory disorders Am J Otol – Head and Neck Medicine and
Surgery, 29 (2008), pp. 333–338
Drobik, R. Laskawi Frey's syndrome: treatment with botulinum toxin Acta Otolaryngol Stockh, 115 (1995), pp. 459–461
P. Drummond Mechanism of gustatory flushing in Frey's syndrome Clin Auton Res, 12 (2002), pp. 144–146
35. FACIAL PAIN
(OTHER THAN MYOFASCIAL ORIGIN)
studies have been conducted B.J. Freund in 2000 G.E. Borodic in 2002
on the use of BTX-A in pain conditions such as tension headache,
myofascial pain, migraine, trigeminal neuralgia, bruxism and
hemifacial contracture after seventh cranial nerve injury.
G. Borodic in 2002 BTX-A was found promising in postoperative
wound pain including reconstructive facial and oral surgery,
traditional and endoscopic sinus surgery, TMJ surgery and blowout
fracture repair. Chronic facial pain following post-dental procedures
was associated with a poor results.
G.E. Borodic, , M.A. Acquadro The Use of Botulinum Toxin for the Treatment of Chronic Facial Pain J Pain, 3 (2002), pp. 21–27
B.J. Freund M. Schwartz Treatment of chronic cervical-associated headache with botulinum toxin A: A pilot study Headache, 40 (2000), pp. 231–
236
G. Borodic, M. Acquadro Management of facial pain with botulinum toxin in a tertiary pain clinic
Naunyn Schmiedebergs Arch Phannacol, 365 (Suppl 2) (2002), p. R14
36. FACIAL NERVE PALSY (FNP)
S.A. Sadiq in 1998 and M.F. Ellis etal 2001, BTX injection, through an
orbital route or a skin crease, provides a good means of inducing a
protective ptosis by temporarily paralyzing the levator palpebrae
superioris
G.C. Gusek-Schneider, etal in 1998 This intentionally induced ptosis
may be useful in intensive care patients to prevent desiccation of
the cornea.
R.J. Hofmann in 2000 and F.J. Montoya in 2002 An aberrant
connection of the salivary sceromotor fibres to the fibres of the
lacrimal gland may develop after a facial palsy, causing a
hyperlacrimation whenever the patient salivates (crocodile tears).
Injection of BTX into the lacrimal gland is a successful treatment for
hyperlacrimation in these cases .
M.F. Ellis, M. Daniell An evaluation of the safety and efficacy of botulinum toxin type A (BOTOX) when used to produce a protective ptosis Clin Exp Ophthalmol, 29
(2001), pp. 394–399
S.A. Sadiq, R.N. Downes A clinical algorithm for the management of facial nerve palsy from an oculoplastic perspective Eye, 12 (Pt 2) (1998), pp. 219–
223
G.C. Gusek-Schneider, etal Protective ptosis by botulinum A toxin injection in corneal affectations Klin Monatsbl Augenheilkd, 213 (1998), pp. 15–22
R.J. Hofmann Treatment of Frey's syndrome (gustatory sweating) and ‘crocodile tears’ (gustatory epiphora) with purified botulinum toxin Ophthalmic
Plast Reconstr Surg, 16 (2000), pp. 289–291
F.J. Montoya, etal Treatment of gustatory hyperlacrimation (crocodile tears) with injection of botulinum toxin into the lacrimal gland Eye, 16 (2002), pp.
705–709
37. FACIAL NERVE PALSY (FNP)
M.W. Armstrong in 1996, N.W. Bulstrode and R.P. Clark, in 2005, In
patients with facial asymmetry, chemo-denervation of the normal
side with BTX has been reported to be an effective disguising tool.
In this setting, BTX reduces the relative hyperkinesis of the
contralateral side to the paralysis, resulting in a more symmetrical
function of the face.
M.W. Armstrong, etal Treatment of facial synkinesis and facial asymmetry with botulinum toxin type A following facial nerve palsy Clin
Otolaryngol Allied Sci, 21 (1996), pp. 15–20
N.W. Bulstrode, D.H. Harrison The phenomenon of the late recovered Bell's palsy: treatment options to improve facial symmetry
Plast Reconstr Surg, 115 (2005), pp. 1466–1471
R.P. Clark, C.E. Berris Botulinum toxin: a treatment for facial asymmetry caused by facial nerve paralysis Plast Reconstr Surg, 115
(2005), pp. 573–574
38. OTHER NERVE PALSIES
H.S. Metz in 1988, N. Saad, in 1992 and M.R. Talebnejad, etal in
2008, There are few reports (level 4 evidence) of BTX injection to
the lateral rectus muscle for treatment of third-nerve palsy.
M.L. Mazow in 1999 BTX injection decreases the likelihood of
contracture of the lateral rectus muscle, thereby allowing return of
medial rectus muscle function
N.L. Rowe, L.I. Williams in Maxillofacial injuries (2nd edition), The
abducens nerve can be injured during a severe orbital trauma.
• H.S. Metz, M. Mazow Botulinum toxin treatment of acute sixth and third nerve palsy Graefes Arch Clin Exp Ophthalmol, 226 (1988), pp. 141–144
• N. Saad, J. Lee The role of botulinum toxin in third nerve palsy Aust N Z J Ophthalmol, 20 (1992), pp. 121–127
• M.R. Talebnejad, etal The role of Botulinum toxin in management of acute traumatic third-nerve palsy J AAPOS, 12 (2008), pp. 510–
513
• M.L. Mazow Third cranial nerve palsy: Diagnosis and management strategies A.L. Rosenbaum, A.P. Santiago (Eds.), Clinical
Strabismus Management: Principles and Surgical Technique, W.B. Saunders, Philadelphia (PA) (1999), pp. 251–258
• N.L. Rowe, L.I. Williams Fracture of the zygomatic complex and orbit L.I. Williams (Ed.), Rowe and Williams’ Maxillofacial injuries (2nd
edition), Vol. 1, Churchill Livingstone (1994), p. 515
39. MUSCLE MOVEMENT DISORDERS
BTX has been used since 1977 as a therapeutic agent in the
treatment of numerous neuromuscular disorders.
A Blitzer, etal in 1997 Matarasso, etal in 1999, M.A. Kane in1999 R.
Laskawi,etal in 2002, A specific type in this category is hyperkinesia
of the platysma. In the literature, data on successful treatment of the
platysma with BTX are nearly always related to its use for aesthetic
indications. BTX also provides a favorable therapeutic option
• A Blitzer, etal The management of hyperfunctional facial lines with botulinum toxin: A collaborative study of 210 injection sites in 162
patients Arch Otolaryngol Head Neck Surg, 123 (1997), pp. 389–392
• F.S. Brandt, B. Bellman Cosmetic use of botulinum toxin Aexotoxin for the aging neck Dermatol Surg, 24 (1998), pp. 1232–1234
• M.A. Kane Nonsurgical treatment of platysmal bands with injection of botulinum toxin A Plast Reconstr Surg, 103 (1999), pp. 656–663
• Matarasso, etal Botulinum A exotoxin for the management of platysma bands Plast Reconstr Surg, 103 (1999), pp. 645–652
• R. Laskawi,etal, SurgicalnNonsurgical Treatment Options in Patients With Movement Disorders of the Platysma J Oral Maxillofac Surg,
60 (2002), pp. 157–162
40. MUSCLE MOVEMENT
DISORDERS
J. Jankovic, etal in 1987 reported that BTX-A injections are considered a safe and
efficient local treatment for focal dystonia and muscle spasms 105
condition Author
Oromandibular dystonia 1. Blitzeretal etal Ann Otol Rhinol Laryngol, 98 (1989), pp. 93–97
2. N. Hermanowicz, etalLaryngoscope, 101 (1991), pp. 1216–1218
3. E.K. Tan etalNeurology, 53 (1999), pp. 2102–2107
Cervical dystonia
(spasmodic torticollis)
1. A. Brashear etal Neurology, 53 (1999), pp. 1439–1446
2. M.F. Brin, etal Neurology, 53 (1999), pp. 1431–1438
3. C.L. Comella, etal Neurology, 65 (2005), pp. 1423–1429
4. R. Stell etal BMJ, 297 (1988), p. 616
Hemifacial spasm 1. M.F. Brin, etal Mov Disord, 2 (1987), pp. 237–254
2. Y.C. Park etal J Korean Med Sci, 8 (1993), pp. 334–340
3. E.K. Tan etal J Neurol Sci, 219 (1–2) (2004), pp. 151–155
4. D.M. Yoshimura etal Muscle Nerve, 15 (1992), pp. 1045–1049
Tardive dyskinesia 1. E. Stip etal Br J Psychiatry, 161 (1992), pp. 867–868
2. D.D. Truong, etal J Clin Psychopharmacol, 10 (1990), pp. 438–439
3. J. Yasufuku-etal J Neurol Neurosurg Psychiatry, 58 (1995), pp. 511–512
Tardive tongue
protrusion dystona
1. P.D. Charles etalSouth Med J, 90 (1997), pp. 522–525
2. S.A. Schneider, etal Neurology, 67 (2006), pp. 940–943
41. PERIOPERATIVE USE OF BOTULINUM
TOXINS
Adler C. in 2008 reported that In maxillofacial surgery,
patients undergoing eyelid reconstructive surgery had
successful wound healing after adjunct treatment with
BTX.
G. Lger in 2006 BTX was better than placebo in the
wound healing of facial lacerations requiring surgery.
G. Mckellar etal in 1992 reported that BTA has been
used to immobilize muscles after jaw fractures to reduce
the displacing forces on the fracture ends and obtain
good immobilization especially if rigid internal fixation is
not available or feasible.
• Adler C. Perioperative Use Of Botulinum Toxins. Abstracts Toxins 2008; Toxicon 51: 44
• G. Lger, etal Botulinum toxin to improve facial wound healing: a prospective, blinded, placebo-controlled study Mayo Clin Proc, 81 (2006), pp. 1023–1028
• G. Mckellar, etalThe use of botulinum-toxin in the treatment of oromandibular dystonias and fractures of the mandibular condyle Aust N Z J Med, 22 (1992),
p. 428
42. PERIOPERATIVE USE OF BOTULINUM
TOXINS
K.A. Stefan etal in 2007 reported that BTX has also
been beneficial during the initial osseointegration phase
for dental implants.
This indication is mostly experimental, but some authors
have found it to be safe and effective in the prophylactic
reduction of masseter and temporalis muscle strength
after implantation in immediate loading protocols.
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 104 (2007), pp. e1–e11)
43. COMPLICATIONS
The most important side effects reported for cosmetic
use of BTX include immunogenicity, allergy and local
complications.
Neutralizing antibodies to BTX-A toxins can lead to loss
of treatment effect.
M.F. Brin etal in 1999 reported clinical resistance to
BTX-A has been estimated as high as 7%.
A. Brashear and M.F. Brin etal in 1999 investigated
BTX-B as an alternative therapeutic agent.
M.F. Brin, etal Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-resistant cervical dystonia Neurology, 53 (1999), pp.
1431–1438
A. Brashear, etal Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-responsive cervical dystonia Neurology, 53
(1999), pp. 1439–1446
44. COMPLICATIONS
J.C. Cather etal in 2002 and J. Niamtu in 2003
reported Adverse effects such as pain, oedema,
erythema, ecchymosis and short-term hypoesthesia may
occur after injection of BTX-A.
J. Niamtu, S.Z. Said in 2003 and R.S. Stern in 2004
reported other adverse events like headache,
blepharoptosis and perioral muscular palsy.
J.C. Cather, etal Update on botulinum toxin for facial aesthetics Dermatol Clin, 20 (2002), pp. 749–761
J. Niamtu Botulinum Toxin A: A Review of 1,085 Oral and Maxillofacial Patient Treatments J Oral Maxillofac Surg, 61 (2003), pp. 317–324
S.Z. Said, etal Botulinum toxin A: its expanding role in dermatology and esthetics Am J Clin Dermatol, 4 (2003), pp. 609–616
R.S. Stern Clinical practice. Treatment of photoaging N Engl J Med, 350 (2004), pp. 1526–1534
45. COMPLICATIONS
IN THERAPEUTIC APPLICATIONS
In therapeutic applications, complications were mostly local and relatively mild,
such as pain, erythema, ecchymosis of the region injected, dry eyes, mouth droop,
ptosis and lid edema, facial muscle weakness, asymmetry of facial expression
during dynamic facial movements, xerostomia, transient dysphagia, restricted
mouth opening, nasal regurgitation and nasal speech, headache, blurred vision,
dizziness, upset stomach, infection, neck weakness, voice changes, difficulties in
chewing and breathing risk of aspiration, recurrent jaw dislocation, dysarthria,
salivary duct calculi and local injuries of the carotid arteries or branches of the
facial nerve
A. Blitzer in 1989, M.F. Brin in 1995, G.E. Borodic in 2002, C.L. Comella in 2005
• A. Blitzer, M.F. Brin, P.E. Greene, S. FahnBotulinum toxin injection for the treatment of oromandibular dystoniaAnn Otol Rhinol Laryngol, 98 (1989), pp. 93–97
• G.E. Borodic, M.A. Acquadro The Use of Botulinum Toxin for the Treatment of Chronic Facial Pain J Pain, 3 (2002), pp. 21–27
• M.F. Brin, A. Blitzer, S. Herman Orofaciomandibular and lingual dystonia A.P. Moore (Ed.), Handbook of Botulinim Toxin Treatment, Blackwell Scientific,
Oxford, England (1995), pp. 151–163
• M.F. Brin, A. Blitzer, S. Herman Oromandibular dystonia: Treatment of 96 patients with botulinum toxin J. Jankovic, M. Hallett (Eds.), Therapy With Botulinum
Toxin., Marcel Dekker, New York, NY (1994), pp. 429–435
• M.F. Brin, S. Fahn, C. Moskowitz Localized injections of botulinum toxin for the treatment of focal dystonias and hemifacial spasm Mov Disord, 2 (1987), pp.
237–254
• C.L. Comella, J. Jankovic, K.M. Shannon, J. Tsui, M. Swenson, S. Leurgans Comparison of botulinum toxin serotypes A and B for the treatment of cervical
dystonia Neurology, 65 (2005), pp. 1423–1429
46. COMPLICATIONS
A. Blitzer in 1989 reorted that Systemic side effects are rarely
reported, generally not dose related, and can include transient
weakness, fatigue, nausea and pruritis.
B. Bentsianov in 2004 reported that Flu-like syndromes have
been reported, but they are generally of brief duration.
M.F. Lew in 1997, A. Brashear, M.F. Brin in 1999 and D.
Dressler in 2003 reported some adverse effects such as
xerostomia and dysphagia are more frequently seen after
treatment with BTX-B than BTX-A.
• A. Blitzer, M.F. Brin, P.E. Greene, S. FahnBotulinum toxin injection for the treatment of oromandibular dystoniaAnn Otol Rhinol Laryngol, 98 (1989), pp. 93–
97
• B. Bentsianov etal Botulinum toxin treatment of temporomandibular disorders, masseteric hypertrophy, and cosmetic masseter reduction Oper Tech
Otolaryngol Head Neck Surg, 15 (2004), pp. 110–113
• Brashear, etal Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-responsive cervical dystonia Neurology, 53 (1999), pp. 1439–1446
• M.F. Brin, etal Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-resistant cervical dystonia Neurology, 53 (1999), pp. 1431–1438
• D. Dressler, R. Benecke Autonomic side effects of botulinum toxin type B treatment of cervical dystonia and hyperhidrosis Eur Neurol., 49 (2003), pp. 34–
38M.F. Lew, etal Botulinum toxin type B: A double-blind, placebo-controlled, safety and efficacy study in cervical dystonia Neurology, 49 (1997), pp. 701–
707
47. CONTRAINDICATIONS
Allergan lists Botox contraindications as (Botox Package Insert. Irvine, CA,
Allergan, Inc.)
1. Pregnancy and breastfeeding,
2. Disorders of the neuromuscular junction (myasthenia gravis,
amyotrophic lateralizing sclerosis, myopathies)
3. Theoretical drug interactions (aminoglycoside antibiotics,
quinidine, calcium channel blockers, magnesium sulfate,
succinylcholine, and polymyxin).
W. Huang etal in 2001 (J Am Acad Dermatol, 43 (2 Pt 1) (2000), pp. 249–259)
1. Eaton–lambert syndrome
2. Hypersensitivity to BTX or one of its ingredients.
48. POTENTIAL THERAPEUTIC USES
TOPICAL FORMULATIONS
• De Almeida AT Dermatol Surg 2007: 33(1 Spec No.):S37–S43
• Moreau MS Br J Dermatol 2003: 149: 1041–1045.
• Talarico-Filho S etal Dermatol Surg 2007: 33(1 Spec No.):S44–S50
• Glogau RG in 2007 Dermatol Surg 2007: 33(1 Spec No.):S76–S80.
• Moreau MS etal in 2003, De Almeida AT etal and,
Talarico-Filho S etal in 2007, Because intradermal BTX
injection has been successful in treating focal hyperhidrosis of
the palms, soles, axillae and facial areas. investigators have
considered the potential for a topical formulation.
• Glogau RG in 2007 Topical BTX has been used for axillary
hyperhidrosis with promising results
49. KELOID AND HYPERTROPHIC SCAR
Clinical observations of A. David etal in 2002, G. Lger
etal in 2006 and X. Zhibo etal in 2008 indicate that BTX-
A can improve the appearance of hypertrophic scar and
inhibit its growth.
A. Carruthers etal in 2001 reported the evidence
supporting this potential use arise from BTX's ability to
prevent excessive muscle contraction of the skin near
keloid tissue.
X. Zhibo etal in 2008 and C.-C. Yao etal in 2006
reported its influence on cellular apoptosis and cellular
proliferation.
• A. David, etal Botulinum toxin to minimize facial scarring Facial Plast Surg, 18 (2002), pp. 35–39
• G. Lger, etal Botulinum toxin to improve facial wound healing: a prospective, blinded, placebo-controlled study Mayo Clin Proc, 81 (2006), pp. 1023–1028
• X. Zhibo, etal Potential therapeutical effects of botulinum toxin type A in keloid management Medical Hypotheses, 71 (2008), p. 623
• A. Carruthers, etal Botulinum toxin type A: History and current cosmetic use in the upper face Semin Cutan Med Surg, 20 (2001), pp. 71–84
• X. Zhibo, etal Botulinum toxin type A affects cell cycle distribution of fibroblasts derived from hypertrophic scar J Plast Reconstr Aesthet Surg, 61 (2008), pp.
1128–1129
• C.-C. Yao, etal Novel action of botulinum toxin on the stromal and epithelial components of the prostate gland J Urol, 175 (2006), pp. 1158–1163
Editor's Notes
This paper reviews the established and emerging applications of BTX in the field of oral and maxillofacial surgery. An overview of the pharmacology, toxicity and preparations of the agent is given.
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In the maxillofacial region, most studies on the use of BTX are of low quality (noncomparative, non-randomized trials), but the overall results were promising.
’. In 1870, Muller, another German physician, coined the name BOTULISM. The Latin form is botulus, which means sausage.
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Since then, its therapeutic applications have expanded into many different fields, often with innovative treatments and surprising results.
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147
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Pharmacology of botulinum toxin
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216 P.T. Ting, A. Freiman
The story of Clostridium botulinum: From food poisoning to BOTOX
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91
J.L. Halpern, L.A. Smith, K.B. Seamon, K.A. Groover, W.H. Habig
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The estimated human dose (assuming a weight of 70 kg) of type A toxin lethal to 50% of an exposed population (the LD50) is estimated, 33
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E.J. Schantz, E.A. Johnson Properties and use of botulinum toxin and other microbial neurotoxins in medicine Microbiol Rev., 56 (1992), pp. 80–99
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A.B. Scott, D. Suzuki Systemic toxicity of botulinum toxin by intramuscular injection in the monkey Mov Disord., 3 (1988), pp. 333–335
23
M.F. Brin
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A. Blitzer (Ed.), Management of facial lines and wrinkles, Lippincott, Williams and Wilkins, Philadelphia (2000 p), pp. 279–302
The 7 neurotoxins have different specific toxicities,87, 113 and 151 different durations of persistence in nerve cells49 and 74, and different potencies5. All BTX serotypes, ultimately, inhibit acetylcholine release.
193
C.M. Shaari
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150
J. O’day
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A number of BTX preparations have been approved in different countries. Currently, there are 6 different BTXs available on the market, 5 contain
187
A.B. Scott, A. Rosenbaum, C.C. Collins
Pharmacologic weakening of extraocular muscles
Invest Ophthalmol, 12 (1973), pp. 924–927
216 P.T. Ting, A. Freiman
The story of Clostridium botulinum: From food poisoning to BOTOX
Clin Med, 4 (2004), pp. 258–261
53
Dressler D, Mander GJ, Fink K. Equivalent potency of Xeomin and BOTOX. Abstracts Toxins 2008/Toxicon 51: 10.
229
K. Wohlfarth, C. Muller, I. Sassin, G. Comes, S. Grafe
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Clin Neuropharmacol, 30 (2007), pp. 86–94
BTX-B is available as Myobloc (Solstice Pharmaceuticals, South San Francisco, CA, USA) and is marketed as Neurobloc (Elan Pharmaceuticals, Shannon, County Clare, Ireland)135.
135 S.L. Matarasso Comparison of botulinum toxin types A and B: A bilateral and double-blind randomized evaluation in the treatment of canthal rhytides Dermatol Surg, 29 (2003), pp. 7–13
163 A.L. Ramirez, J. Reeck, C.S. Maas Botulinum toxin type B (MyoBloc) in the management of hyperkinetic facial lines Otolaryngol Head Neck Surg, 126 (2002), pp. 459–467
3 T. Alster, J. Lupton Botulinum toxin type B for dynamic glabellar rhytides refractory to botulinum toxin type A Dermatol Surg, 29 (2003), pp. 516–518
11 L. Baumann, A. Stezinger, J. Vujevich, M. Halem, J. Bryde, L. Black A double-blinded, randomized, placebo-controlled pilot study of the safety and efficacy of Myobloc (botulinum toxin type B)-purified neurotoxin complex for the treatment of crow's feet: A double-blinded, placebo- controlled trial Dermatol Surg, 29 (2003), pp. 508–515
119 M.F. Lew, A. Brashear, S. Factor The safety and efficacy of botulinum toxin type B in the treatment of patients with cervical dystonia: Summary of three controlled clinical trials Neurology, 55 (12 Suppl 5) (2000), pp. S29–S35
125 N.J. Lowe, P.S. Yamauchi, G.P. Lask, R. Patnaik, D. Moore Botulinum toxins types A and B for brow furrows: Preliminary experiences with type B toxin dosing J Cosmet Laser Ther, 4 (2002), pp. 15–18
135 S.L. Matarasso Comparison of botulinum toxin types A and B: A bilateral and double-blind randomized evaluation in the treatment of canthal rhytides Dermatol Surg, 29 (2003), pp. 7–13
163 A.L. Ramirez, J. Reeck, C.S. Maas Botulinum toxin type B (MyoBloc) in the management of hyperkinetic facial lines Otolaryngol Head Neck Surg, 126 (2002), pp. 459–467
174 N. Sadick Prospective open-label study of botulinum toxin type B (Myobloc) at doses of 2,400 and 3,000 U for the treatment of glabellar wrinkles Dermatol Surg, 29 (2003), pp. 501–507
175 N.S. Sadick Botulinum toxin type B for glabellar wrinkles: A prospective open-label response study Dermatol Surg, 28 (2002), pp. 817–821
176 N.S. Sadick, S.L. Matarasso Comparison of botulinum toxins A and B in the treatment of facial rhytides Dermatol Clin, 22 (2004), pp. 221–226
70
T.C. Flynn Myobloc Dermatol Clin, 22 (2004), pp. 207–211
73
T.C. Flynn, R.E. Clark Botulinum toxin type B (MYOBLOC) versus botulinum toxin type A (BOTOX) frontalis study: rate of onset and radius of diffusion Dermatol Surg, 29 (2003), pp. 519–522
125 N.J. Lowe, P.S. Yamauchi, G.P. Lask, R. Patnaik, D. Moore
Botulinum toxins types A and B for brow furrows: Preliminary experiences with type B toxin dosing
J Cosmet Laser Ther, 4 (2002), pp. 15–18
135
S.L. Matarasso
Comparison of botulinum toxin types A and B: A bilateral and double-blind randomized evaluation in the treatment of canthal rhytides
Dermatol Surg, 29 (2003), pp. 7–13
163
A.L. Ramirez, J. Reeck, C.S. Maas
Botulinum toxin type B (MyoBloc) in the management of hyperkinetic facial lines
Otolaryngol Head Neck Surg, 126 (2002), pp. 459–467
77
S.R. Freeman, J.L. Cohen
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F. Hegedus in 2006 Glabellar lines, also called frown lines, occur naturally with facial animation, as a result of the pulling of the skin by the underlying musculature, predominantly the procerus muscle and the corrugator supercilii. With aging and chronic activity of the facial muscles, these lines become more prominent93.
68 S. Fagien, F.S. Brandt Primary and adjunctive use of botulinum toxin type A (Botox) in facial aesthetic surgery: beyond the glabella Clin Plast Surg, 28 (2001), pp. 127–148
J.E. Frampton, S.E. Easthope Botulinum toxin A (Botox cosmetic): a review of its use in the treatment of glabellar frown lines Am J Clin Dermatol, 4 (2003), pp. 709–725
147 J. Niamtu Aesthetic uses of botulinum toxin A J Oral Maxillofac Surg, 57 (1999), pp. 1228–1233
The technique for injecting BTX is generally simple and most patients tolerate injections without anesthesia quite well, although topical anesthetics are used by some practitioners. Some have used acid mantle cream mixed with lidocaine (4%) and Lidoderm patches (lidocaine 5%)146. Many patients treated with topical anesthesia elected not to use it for subsequent treatments148.
147 J. Niamtu Aesthetic uses of botulinum toxin A J Oral Maxillofac Surg, 57 (1999), pp. 1228–1233
148 J. Niamtu Botulinum Toxin A: A Review of 1,085 Oral and Maxillofacial Patient Treatments J Oral Maxillofac Surg, 61 (2003), pp. 317–324
149 J. Niamtu Cosmetic facial surgery Oral Maxillofac Surg Clin North Am, 12 (2000), p. 595
Masseteric hypertrophy usually results from anatomical asymmetry of the jaw, habitual asymmetric use of the jaw, clenching during exercise or sleep, excessive chewing of gum or congenital malformations. It may be unilateral or bilateral.
Many reports on BTX-A treatment for TMJ disorders have dealt with TMJ and masticatory muscle pain78 and 79, reduced jaw opening capacity10 and 202, recurrent TMJ dislocations143, 195 and 235, and masticatory hyperactivity225. Most of these studies were case series (level 4 evidence)
Temporomandibular disorders (TMDs) are subgroups of musculoskeletal and rheumatologic disorders, and are considered the major cause of pain in the orofacial region152. TMDs may be divided into those related to the muscles acting on the joint (myofascial) and those related to the joint itself (arthrogenic). Joint noise, pain and a restricted range of mandibular motion are the most frequent symptoms of TMD58. Directing treatment at the muscular component of TMD, which in some patients can be identified as non-spastic clenching or bruxism, could yield important therapeutic gains. BTX-A has been effective in the treatment of some patients with TMD with high specificity as well as tolerable side-effects82. Injections are usually performed under electromyographic or ultrasonic control12 and 82.
.
Earlier studies suggest that displacement of the articular disc may be caused, precipitated or maintained by lateral pterygoid activity or friction between the articular surfaces of the disc and condyle causing clicking48, 115 and 128.
of the TMJ, but, in some reports, the superficial part of the masseter at the angle of the mandible was also injected45.
Dislocation of the TMJ occurs when the mandibular condyle is displaced anteriorly beyond the articular eminence. It represents 3% of all reported dislocated joints123.
Xerostomia is one of the first manifestations of botulism, which led to investigations of its application for sialorrhea and drooling.
With the exception of those with Frey's syndrome who are treated intracutaneously, all of the injections are performed percutaneously, either intraparenchymal or perilesional. In the case of sialoceles, the extravasation fluid should be drained beforehand32. Some authors still use BTX injections under EMG control131 and 132 when treating salivary secretory disorders. According to others, ultrasonographic-assisted intraparenchymal infiltration is preferable and improves efficacy and safety31, 51, 129 and 220. Others have found no difference in undesired effects associated with the method of drug application133
Trauma is a common cause of acquired third-nerve palsy in adults and children 102 and 218. Such patients are less likely to recover than those with palsies of other causes121
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E.B. Ing, T.J. Sullivan, M.P. Clarke, J.R. Buncic
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T. Tokuno, K. Nakazawa, S. Yoshida, S. Matsumoto, T. Shingu, S. Sato
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No Shinkei Geka, 23 (1995), pp. 497–501
Dystonia refers to the involuntary contraction of specific muscles
13 A Blitzer, etal The management of hyperfunctional facial lines with botulinum toxin: A collaborative study of 210 injection sites in 162 patients Arch Otolaryngol Head Neck Surg, 123 (1997), pp. 389–392
Numerous studies document the usefulness of BTX therapy in the treatment of oromandibular dystonia 14, 95 and 213, cervical dystonia (spasmodic torticollis)22, 27, 44 and 203, hemifacial spasm26, 157, 211 and 232, tardive dyskinesia205, 219 and 231, and tardive tongue protrusion dystona40 and 182. Many studies were double-blind randomized trials (level 2 evidence).
In patients with movement disorders who require surgery, the presence of postoperative involuntary movements may be detrimental to healing. BTX weakens the muscle and in so doing may improve postoperative recovery and healing. Wound healing improves if the muscles involved are injected with BTX prior to surgery2.
2 Adler C. Perioperative Use Of Botulinum Toxins. Abstracts Toxins 2008; Toxicon 51: 44
120 G. Lger, etal Botulinum toxin to improve facial wound healing: a prospective, blinded, placebo-controlled study
Mayo Clin Proc, 81 (2006), pp. 1023–1028
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G. Mckellar, etalThe use of botulinum-toxin in the treatment of oromandibular dystonias and fractures of the mandibular condyle Aust N Z J Med, 22 (1992), p. 428
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K.A. Stefan, V.S. Konstantinovic
The therapeutic use of botulinum toxin in cervical and maxillofacial conditions: an evidence-based review
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 104 (2007), pp. e1–e11
Botox has a large margin of safety216.
216 P.T. Ting, A. Freiman
The story of Clostridium botulinum: From food poisoning to BOTOX
Clin Med, 4 (2004), pp. 258–261
27 M.F. Brin, etal Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-resistant cervical dystonia Neurology, 53 (1999), pp. 1431–1438
22 A. Brashear, etal Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-responsive cervical dystonia Neurology, 53 (1999), pp. 1439–1446
In theory, because human albumin is used in the preparation of Botox, a patient could exhibit an allergic reaction,148 but no case has been reported.
39 J.C. Cather, etal Update on botulinum toxin for facial aesthetics Dermatol Clin, 20 (2002), pp. 749–761
148 J. Niamtu Botulinum Toxin A: A Review of 1,085 Oral and Maxillofacial Patient Treatments J Oral Maxillofac Surg, 61 (2003), pp. 317–324
178 S.Z. Said, etal Botulinum toxin A: its expanding role in dermatology and esthetics Am J Clin Dermatol, 4 (2003), pp. 609–616
204 R.S. Stern Clinical practice. Treatment of photoaging N Engl J Med, 350 (2004), pp. 1526–1534
, 14 A. Blitzer, M.F. Brin, P.E. Greene, S. FahnBotulinum toxin injection for the treatment of oromandibular dystoniaAnn Otol Rhinol Laryngol, 98 (1989), pp. 93–97
18 G.E. Borodic, M.A. Acquadro The Use of Botulinum Toxin for the Treatment of Chronic Facial Pain J Pain, 3 (2002), pp. 21–27
24 M.F. Brin, A. Blitzer, S. Herman Orofaciomandibular and lingual dystonia A.P. Moore (Ed.), Handbook of Botulinim Toxin Treatment, Blackwell Scientific, Oxford, England (1995), pp. 151–163
25 M.F. Brin, A. Blitzer, S. Herman Oromandibular dystonia: Treatment of 96 patients with botulinum toxin J. Jankovic, M. Hallett (Eds.), Therapy With Botulinum Toxin., Marcel Dekker, New York, NY (1994), pp. 429–435
26 M.F. Brin, S. Fahn, C. Moskowitz Localized injections of botulinum toxin for the treatment of focal dystonias and hemifacial spasm Mov Disord, 2 (1987), pp. 237–254
44 C.L. Comella, J. Jankovic, K.M. Shannon, J. Tsui, M. Swenson, S. Leurgans Comparison of botulinum toxin serotypes A and B for the treatment of cervical dystonia Neurology, 65 (2005), pp. 1423–1429
14, 18, 24, 25, 26, 44, 45, 61, 65, 79, 94, 98, 129, 153, 155, 157, 159, 162, 207, 214, 228 and 232.
Contraindications to BTX-A are generally few. In many studies, no complaints were received about systemic problems associated with cosmetic injection.
Lambert-Eaton myasthenic syndrome (LEMS) is a rare presynaptic disorder of neuromuscular transmission in which quantal release of acetylcholine (ACh) is impaired, causing a unique set of clinical characteristics, which include proximal muscle weakness, depressed tendon reflexes, posttetanic potentiation, and autonomic changes. The initial presentation can be similar to that of myasthenia gravis (MG), but the progressions of the 2 diseases have some important differences.
LEMS disrupts the normally reliable neurotransmission at the neuromuscular junction (NMJ). This disruption is thought to result from an autoantibody-mediated removal of a subset of the P/Q-type Ca2+ channels involved with neurotransmitter release.[1]
In 40% of patients with LEMS, cancer is present when the weakness begins or is found later. This is usually a small cell lung cancer (SCLC), although LEMS has also been associated with non-SCLC, lymphosarcoma, malignant thymoma, or carcinoma of the breast, stomach, colon, prostate, bladder, kidney, or gallbladder.[1]
Clinical manifestations frequently precede cancer identification. In most cases, the cancer is discovered within the first 2 years after onset of LEMS and, in virtually all cases, within 4 years
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Because intradermal BTX injection has been successful in treating focal hyperhidrosis of the palms, soles, axillae and facial area
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C.-C. Yao, etal Novel action of botulinum toxin on the stromal and epithelial components of the prostate gland J Urol, 175 (2006), pp. 1158–1163