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Eckstein A, Welkoborsky HJ. [Interdisciplinary Management of Orbital Diseases]. Laryngorhinootologie 2024; 103:S43-S99. [PMID: 38697143 DOI: 10.1055/a-2216-8879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Diagnosis and therapy of orbital diseases is an interdisciplinary challenge, in which i.e. otorhinolaryngologists, ophthalmologists, radiologists, radiation therapists, maxillo-facial surgeons, endocrinologists, and pediatricians are involved. This review article describes frequent diseases which both, otolaryngologists and ophthalmologists are concerned with in interdisciplinary settings. In particular the inflammatory diseases of the orbit including orbital complications, autoimmunological diseases of the orbit including Grave´s orbitopathy, and primary and secondary tumors of the orbit are discussed. Beside describing the clinical characteristics and diagnostic steps the article focusses on the interdisciplinary therapy. The review is completed by the presentation of most important surgical approaches to the orbit, their indications and possible complications. The authors tried to highlight the relevant facts despite the shortness of the text.
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Affiliation(s)
| | - H-J Welkoborsky
- Univ. Klinik für Augenheilkunde Universitätsmedizin Essen, Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Klinikum Nordstadt der KRH
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Eckstein A, Stöhr M, Görtz GE, Gulbins A, Möller L, Fuehrer-Sakel D, Oeverhaus M. Current Therapeutic Approaches for Graves' Orbitopathy - are Targeted Therapies the Future? Klin Monbl Augenheilkd 2024; 241:48-68. [PMID: 37799096 DOI: 10.1055/a-2186-5548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Graves' orbitopathy is an autoimmune disease of the orbit that most frequently occurs with Graves' hyperthyroidism. The occurrence of autoantibodies directed against the TSH receptor (TRAb) is of central importance for the diagnosis and pathogenesis. These autoantibodies are mostly stimulating, and induce uncontrolled hyperthyroidism and tissue remodelling in the orbit and more or less pronounced inflammation. Consequently, patients suffer to a variable extent from periocular swelling, exophthalmos, and fibrosis of the eye muscles and thus restrictive motility impairment with double vision. In recent decades, therapeutic approaches have mainly comprised immunosuppressive treatments and antithyroid drug therapy for hyperthyroidism to inhibit thyroid hormone production. With the recognition that TRAb also activates an important growth factor receptor, IGF1R (insulin-like growth factor 1 receptor), biological agents have been developed. Teprotumumab (an inhibitory IGF1R antibody) has already been approved in the USA and the therapeutic effects are enormous, especially with regard to the reduction of exophthalmos. Side effects are to be considered, especially hyperglycaemia and hearing loss. It is not yet clear whether the autoimmune reaction (development of the TRAb/attraction of immunocompetent cells) is also influenced by anti-IGF1R inhibiting agents. Recurrences after therapy show that the inhibition of antibody development must be included in the therapeutic concept, especially in severe cases.
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Affiliation(s)
- Anja Eckstein
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
| | - Mareile Stöhr
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
| | - Gina-Eva Görtz
- Labor für Molekulare Augenheilkunde, Universität Duisburg-Essen, Duisburg, Deutschland
| | - Anne Gulbins
- Labor für Molekulare Augenheilkunde, Universität Duisburg-Essen, Duisburg, Deutschland
| | - Lars Möller
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsklinikum Essen, Deutschland
| | - Dagmar Fuehrer-Sakel
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsklinikum Essen, Deutschland
| | - Michael Oeverhaus
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
- Gemeinschaftspraxis Dres. Oeverhaus & Weiß, Rietberg, Deutschland
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Wu WT, Chang KV, Chang HC, Chen LR, Kuan CH, Kao JT, Wei LY, Chen YJ, Han DS, Özçakar L. Ultrasound Imaging of the Facial Muscles and Relevance with Botulinum Toxin Injections: A Pictorial Essay and Narrative Review. Toxins (Basel) 2022; 14:toxins14020101. [PMID: 35202129 PMCID: PMC8878462 DOI: 10.3390/toxins14020101] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
High-resolution ultrasound is preferred as the first-line imaging modality for evaluation of superficial soft tissues, such as the facial muscles. In contrast to magnetic resonance imaging and computed tomography, which require specifically designated planes (axial, coronal and sagittal) for imaging, the ultrasound transducer can be navigated based on the alignment of facial muscles. Botulinum toxin injections are widely used in facial cosmetic procedures in recent times. Ultrasonography is recognized as a useful tool for pre-procedure localization of target muscles. In this pictorial review, we discuss the detailed sonoanatomy of facial muscles and their clinical relevance, particularly with regard to botulinum toxin injections. Furthermore, we have summarized the findings of clinical studies that report ultrasonographic imaging of facial muscles.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
- Correspondence: ; Tel.: +886-2-2371-7101-5309
| | - Hsiang-Chi Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Lan-Rong Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.); (D.-S.H.)
| | - Chen-Hsiang Kuan
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Jung-Ting Kao
- Department of Dermatology, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Ling-Ying Wei
- Department of Dentistry, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Yunn-Jy Chen
- Department of Dentistry, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Medical School, Hacettepe University, Ankara 06100, Turkey;
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Ozturk Karabulut G, Fazil K, Saracoglu Yilmaz B, Ozturker C, Günaydın ZK, Taskapili M, Kaynak P. An algorithm for Botulinum toxin A injection for upper eyelid retraction associated with thyroid eye disease: long-term results. Orbit 2020; 40:381-388. [PMID: 32885692 DOI: 10.1080/01676830.2020.1814351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy and complications of transconjunctival Botulinum toxin A injections performed according to an algorithm, for the management of upper eyelid retraction associated with thyroid eye disease. METHODS Seventy one eyes of 60 patients at the inactive stage, who had undergone Botulinum toxin A injection were reviewed retrospectively. Botulinum toxin A was injected transconjunctivally, just above the superior tarsal border of the upper eyelid in doses between 2-15 units according to an algorithm, depending on the amount of retraction. Margin-reflex distances were measured according to the photographs taken under standard conditions before and after the injections at the tenth day, then the second month and the fourth month. Additional Botulinum toxin A injections were performed in patients who had an undercorrection on the tenth day. Complications such as diplopia and ptosis were recorded. RESULTS The study included 38 females, 22 males with a mean age of 43.3 ± 13.1. Normal margin-reflex distances (3-4 mm) were reached in the 58 of 71 eyes (81.7%). Additional injections were needed in eight eyes (11.2%) for residual retraction on the tenth day. Ptosis was the major complication in four eyes for 1-3 weeks after injection. Upper eyelid retraction recurred after 5.1 ± 0.9 months in all patients. CONCLUSION In the treatment of upper eyelid retraction due to thyroid eye disease, transconjunctival injection of Botulinum toxin A is an effective, safe, transient, and repeatable method with few complications in patients. The algorithm used in this study resulted in high success rate in long-term follow-up.
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Affiliation(s)
- Gamze Ozturk Karabulut
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Korhan Fazil
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Basak Saracoglu Yilmaz
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Can Ozturker
- Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Zehra Karaağaç Günaydın
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Muhittin Taskapili
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Pelin Kaynak
- Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
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Kim MJ, Neta M, Davis FC, Ruberry EJ, Dinescu D, Heatherton TF, Stotland MA, Whalen PJ. Botulinum toxin-induced facial muscle paralysis affects amygdala responses to the perception of emotional expressions: preliminary findings from an A-B-A design. BIOLOGY OF MOOD & ANXIETY DISORDERS 2014; 4:11. [PMID: 25694806 PMCID: PMC4332022 DOI: 10.1186/2045-5380-4-11] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/10/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND It has long been suggested that feedback signals from facial muscles influence emotional experience. The recent surge in use of botulinum toxin (BTX) to induce temporary muscle paralysis offers a unique opportunity to directly test this "facial feedback hypothesis." Previous research shows that the lack of facial muscle feedback due to BTX-induced paralysis influences subjective reports of emotional experience, as well as brain activity associated with the imitation of emotional facial expressions. However, it remains to be seen whether facial muscle paralysis affects brain activity, especially the amygdala, which is known to be responsive to the perception of emotion in others. Further, it is unknown whether these neural changes are permanent or whether they revert to their original state after the effects of BTX have subsided. The present study sought to address these questions by using functional magnetic resonance imaging to measure neural responses to angry and happy facial expressions in the presence or absence of facial paralysis. RESULTS Consistent with previous research, amygdala activity was greater in response to angry compared to happy faces before BTX treatment. As predicted, amygdala activity in response to angry faces was attenuated when the corrugator/procerus muscles were paralyzed via BTX injection but then returned to its original state after the effects of BTX subsided. This preliminary study comprises a small sample size and no placebo condition; however, the A-B-A design affords the present sample to serve as its own control. CONCLUSIONS The current demonstration that amygdala responses to facial expressions were influenced by facial muscle paralysis offers direct neural support for the facial feedback hypothesis. Specifically, the present findings offer preliminary causal evidence that amygdala activity is sensitive to facial feedback during the perception of the facial expressions of others. More broadly, these data confirm the utility of using BTX to address the effect of facial feedback on neural responses associated with the perception, in addition to the experience or expression of emotion.
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Affiliation(s)
- M Justin Kim
- Department of Psychological and Brain Sciences, Dartmouth College, 6207 Moore Hall, Hanover, NH 03755, USA
| | - Maital Neta
- Department of Psychology, B84 East Stadium, University of Nebraska-Lincoln, Lincoln, NE 68588-0156, USA
| | - F Caroline Davis
- US Army Natick Soldier Research Development and Engineering Center, Cognitive Science Research Team, 10 Kansas St., Natick, MA 01760, USA ; Department of Psychology, Tufts University, 490 Boston Avenue, Medford, MA 02155, USA
| | - Erika J Ruberry
- Department of Psychology, University of Washington, 119A Guthrie Hall, Seattle, WA 98195, USA
| | - Diana Dinescu
- Department of Psychology, University of Virginia, 102 Gilmer Hall, Charlottesville, VA 22904, USA
| | - Todd F Heatherton
- Department of Psychological and Brain Sciences, Dartmouth College, 6207 Moore Hall, Hanover, NH 03755, USA
| | - Mitchell A Stotland
- Department of Surgery (Plastic) and Pediatrics, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA ; Department of Surgery (Plastic and Craniofacial), Sidra Research and Medical Center, Doha, Qatar
| | - Paul J Whalen
- Department of Psychological and Brain Sciences, Dartmouth College, 6207 Moore Hall, Hanover, NH 03755, USA
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Kaynak-Hekimhan P. Noncosmetic periocular therapeutic applications of botulinum toxin. Middle East Afr J Ophthalmol 2011; 17:113-20. [PMID: 20616916 PMCID: PMC2892125 DOI: 10.4103/0974-9233.63069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Botulinum toxin blocks acetylcholine release at the neuromuscular junction. The drug which was initially found to be useful in the treatment of strabismus has been extremely effective in the treatment of variety of conditions, both cosmetic and noncosmetic. Some of the noncosmetic uses of botulinum toxin applications include treatment of spastic facial dystonias, temporary treatment of idiopathic or thyroid dysfunction-induced upper eyelid retraction, suppression of undesired hyperlacrimation, induction of temporary ptosis by chemodenervation in facial paralysis, and correction of lower eyelid spastic entropion. Additional periocular uses include control of synchronic eyelid and extraocular muscle movements after aberrant regeneration of cranial nerve palsies. Cosmetic effects of botulinum toxin were discovered accidentally during treatments of facial dystonias. Some of the emerging nonperiocular application for the drug includes treatment of hyperhidrosis, migraine, tension-type headaches, and paralytic spasticity. Some of the undesired side effects of periocular applications of botulinum toxin inlcude ecchymosis, rash, hematoma, headache, flu-like symptoms, nausea, dizziness, loss of facial expression, lower eyelid laxity, dermatochalasis, ectropion, epiphora, eyebrow and eyelid ptosis, lagophthalmos, keratitis sicca, and diplopia.
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Schlessinger J, Monheit G, Kane MAC, Mendelsohn N. Time to onset of response of abobotulinumtoxina in the treatment of glabellar lines: a subset analysis of phase 3 clinical trials of a new botulinum toxin type A. Dermatol Surg 2011; 37:1434-42. [PMID: 21745254 DOI: 10.1111/j.1524-4725.2011.02075.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A new botulinum neurotoxin type A formulation, abobotulinumtoxinA (BoNTA-ABO; Medicis Aesthetics Inc., Scottsdale, AZ), was approved in 2009 in the United States for treatment of moderate to severe glabellar lines in adults younger than 65. OBJECTIVE To determine onset of response based on participant assessments recorded from days 1 through 7. MATERIALS & METHODS Time to onset was assessed as a secondary endpoint in four multicenter, double-blind, placebo-controlled, randomized phase 3 trials evaluating BoNTA-ABO efficacy. Participants received 50 to 80 U of BoNTA-ABO (n=1,160) or placebo (n=580) at five injection sites in the glabellar region. Participants self-evaluated and recorded first effects. RESULTS Response on day 1 was 13.4% to 32.5% in participants receiving BoNTA-ABO and 3% to 7% in those receiving placebo. Integrated analysis of three studies showed that 19.7% of participants responded by day 1; median onset was 3 days for BoNTA-ABO and 15 days for placebo. Men responded less frequently in fixed-treatment studies than in the study in which doses were adjusted for muscle mass. CONCLUSIONS Treatment with BoNTA-ABO demonstrates significantly greater reduction in glabellar lines than placebo. Improvement was seen as early as 24 hours, with median time to onset of 2 to 4 days.
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Tremaine AM, McCullough JL. Botulinum toxin type A for the management of glabellar rhytids. Clin Cosmet Investig Dermatol 2010; 3:15-23. [PMID: 21437056 PMCID: PMC3047945 DOI: 10.2147/ccid.s6492] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Indexed: 11/23/2022]
Abstract
There is an increasing demand for minimally-invasive cosmetic procedures to arrest the aging process. Botulinum toxin type A injections are the most commonly used nonsurgical cosmetic procedures in the United States. There has been research spanning over two decades dedicated to safety, efficacy, dosing, and complications of botulinum toxin type A. There are now two Food and Drug Administration (FDA) approved botulinum toxin type A options in the United States: Botox(®) and Dysport(™), with new advances being made in the field.
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Moy R, Maas C, Monheit G, Huber MB. Long-term Safety and Efficacy of a New Botulinum Toxin Type A in Treating Glabellar Lines. ACTA ACUST UNITED AC 2009. [DOI: 10.1001/archfaci.2009.5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ronald Moy
- Moy-Fincher Medical Group, Los Angeles, California (Dr Moy); The Maas Clinic, San Francisco, California (Dr Maas); and Dermatology Associates, Birmingham, Alabama (Dr Monheit). Ms Huber is a medical writer in Maplewood, New Jersey
| | - Corey Maas
- Moy-Fincher Medical Group, Los Angeles, California (Dr Moy); The Maas Clinic, San Francisco, California (Dr Maas); and Dermatology Associates, Birmingham, Alabama (Dr Monheit). Ms Huber is a medical writer in Maplewood, New Jersey
| | - Gary Monheit
- Moy-Fincher Medical Group, Los Angeles, California (Dr Moy); The Maas Clinic, San Francisco, California (Dr Maas); and Dermatology Associates, Birmingham, Alabama (Dr Monheit). Ms Huber is a medical writer in Maplewood, New Jersey
| | - M. Barbara Huber
- Moy-Fincher Medical Group, Los Angeles, California (Dr Moy); The Maas Clinic, San Francisco, California (Dr Maas); and Dermatology Associates, Birmingham, Alabama (Dr Monheit). Ms Huber is a medical writer in Maplewood, New Jersey
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Abstract
Since its introduction into clinical medicine in 1980, botulinum toxin has become a major therapeutic drug with applications valuable to many medical sub-specialties. Its use was spearheaded in ophthalmology where its potential applications have expanded to cover a broad range of visually related disorders. These include dystonic movement disorders, strabismus, nystagmus, headache syndromes such as migraine, lacrimal hypersecretion syndromes, eyelid retraction, spastic entropion, compressive optic neuropathy, and, more recently, periorbital aesthetic uses. Botulinum toxin is a potent neurotoxin that blocks the release of acetylcholine at the neuromuscular junction of cholinergic nerves. When used appropriately it will weaken the force of muscular contraction, or inhibit glandular secretion. Recovery occurs over 3 to 4 months from nerve terminal sprouting and regeneration of inactivated proteins necessary for degranualtion of acetylcholine vesicles. Complications are related to chemodenervation of adjacent muscle groups, injection technique, and immunological mechanisms.
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Affiliation(s)
- Jonathan J Dutton
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC 27599-7040, USA
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Costa PG, Saraiva FP, Matayoshi S. [Morphometric analysis of the palpebral fissure in patients with thyroid-related disfunction before and after application of botulinum toxin]. ACTA ACUST UNITED AC 2006; 50:920-5. [PMID: 17160217 DOI: 10.1590/s0004-27302006000500014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 05/12/2006] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Botulinum toxin is an alternative treatment for retraction of ocular thyroid related dysfunction. The aim of this study was to evaluate the effects of this medication on upper lid position, levator palpebrae superioris muscle function and corneal exposure. METHODS Seven patients were enrolled into the study. The palpebral fissure images were acquired by a digital camera and transferred to a computer video edition program in order to be processed and analyzed. The levator palpebrae superioris muscle function and lacrimal film tests were also studied. RESULTS The distance between upper eyelid superior margin and light reflection on the center of the cornea had a significantly reduction in its measurements after toxin injection. The muscle function was diminished and there were improvement in corneal exposure after treatment. DISCUSSION Botulinum toxin injection could be an alternative treatment for upper eyelid retraction; it may relieve symptoms and improve eye appearance.
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Affiliation(s)
- Patrícia Grativol Costa
- Departamento de Otorrinolaringologia e Oftalmologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, SP.
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Lee C, Kikkawa DO, Pasco NY, Granet DB. Advanced functional oculofacial indications of botulinum toxin. Int Ophthalmol Clin 2005; 45:77-91. [PMID: 15970767 DOI: 10.1097/01.iio.0000167165.25649.e7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Christina Lee
- Shiley Eye Center, MC 0946, University of California-San Diego, 9415 Campus Point Drive, La Jolla, CA 92093, USA
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Abstract
BACKGROUND Nasal wrinkles on the dorsum of the nose can frequently be treated with botulinum toxin type A by injecting a few units into the nasalis muscle. Between 2 and 5 U of botulinum toxin have commonly been used. However, clinicians have observed that some nasal wrinkles persist following nasalis treatment. OBJECTIVE To detail remaining nasal and perinasal rhytids and further injection sites, which can lead to improvement. METHODS Two hundred fifty patients with nasal rhytids were treated between 1997 and 2004. Three units of botulinum toxin type A were injected bilaterally into the nasalis muscle. Patients were seen at 1 month for follow-up, and the remaining rhytids were documented. RESULTS Forty percent of patients had satisfactory treatment of nasal wrinkles with the initial bilateral 3 U injections. Sixty percent of subjects had remaining nasal rhytids following the nasalis muscle injections. Thirty percent o f subjects hadpersistent wrinkles at the root of the nose (nasal orbicular wrinkles), and 30% had wrinkles at the nasal root and between the eyes (nasociliary wrinkles). The injection of botulinum toxin into additional locations according to the anatomic differences of each person showed excellent resolution of the rhytids without complications. CONCLUSION Understanding nasal wrinkle patterns allows for complete wrinkle treatment of the nose beyond simple bilateral treatment of the nasalis. New points of botulinum toxin application improve not only wrinkles at the root of the nose but also wrinkles in the nasoalar area.
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Affiliation(s)
- Bhertha M Tamura
- Dermatology Department, Santo Amaro University, São Paulo, Brazil.
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14
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Nuevas indicaciones en el tratamiento mediante la toxina botulínica tipo A en cosmética: Boca y cuello. Plast Reconstr Surg 2004. [DOI: 10.1097/01.prs.0000124409.17493.b7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Since the commercial launch of Dysport in 1991, after 10 years of clinical studies on its predecessor formulations, this BTX-A product has shown great therapeutic promise with a good safety profile and low incidence of treatment failures. As with all BTX products, Dysport should not be seen as a generic equivalent but as a specific product with individual unit dosing requirements and side effect profiles. Its role as an important BTX-A molecule looks set to expand as new indications for botulinum toxin arise, and as the cosmetic usage of Dysport is approved in countries outside of South America.
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Affiliation(s)
- Andrew C Markey
- St. John's Institute of Dermatology, St. Thomas' Hospital, London SE17EH, UK.
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16
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New Indications for Botulinum Toxin Type A in Cosmetics: Mouth and Neck. Plast Reconstr Surg 2003. [DOI: 10.1097/00006534-200310001-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The past decade has witnessed great progress in our understanding of Graves' opthalmopathy (GO), although its precise immunopathogenesis remains an enigma. Several clinical studies have provided a more rational basis for treatment of this distressing disease, which significantly lowers the quality of life. A management plan tailored to the patient's needs can be devised according to the severity and activity of the eye disease. In active GO, immunosuppression might be considered. The combination of intravenous pulses of methylprednisolone and retrobulbar irradiation improves eye changes in 88% of patients, and is well tolerated. Once the disease has become inactive, rehabilitative surgery could be performed (orbital decompression, strabismus surgery and eyelid surgery, in that order). The patient should be reassured that functional and cosmetic improvement of eye changes is feasible, but restoration can require one to two years. To a certain extent, refraining from smoking prevents the development or worsening of GO.
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Affiliation(s)
- Wilmar M Wiersinga
- Dept Endocrinology and Metabolism, Academic Medical Center F5-171, Meibergdreef 9, 1105 Amsterdam, The Netherlands.
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Spósito MMM. New indications for botulinum toxin type a in cosmetics: mouth and neck. Plast Reconstr Surg 2002; 110:601-11; discussion 612-3. [PMID: 12142684 DOI: 10.1097/00006534-200208000-00037] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Botulinum toxin type A is frequently used to smooth hyperkinetic lines in the periocular and forehead areas of the upper face, but it has been used less frequently for indications in the lower face and neck. This study was designed to determine whether botulinum toxin treatment of the mouth and neck areas is as clinically successful as the treatment of the upper face. This was a retrospective study of patients who were treated with botulinum toxin type A (Botox) to soften hyperkinetic facial wrinkles. Of 100 patients randomly selected from a single clinical practice, 91 met the inclusion criteria and were divided into two groups for analysis. The 56 patients in group 1 did not receive treatment in the mouth and neck areas, whereas the 35 patients in group 2 were treated at least once in the mouth and neck areas. Patients were surveyed for periods ranging from 7 to 49 months. Most patients in each group had a single botulinum procedure during this period. Both groups of patients had comparable improvement of wrinkles both at the evaluation immediately after the neuromuscular blockade and during follow-up. In comparison with patients whose treatment was confined to the upper face, patients who received global treatment with botulinum toxin type A, including injections in the mouth and neck areas, were injected in more sites per procedure and had more procedures in combination with other therapies. Patient satisfaction with botulinum toxin treatment and outcomes was high in both groups. Botulinum toxin type A is an important tool within the therapeutic spectrum for the treatment of hyperkinetic facial wrinkles, including those in the areas of the mouth and neck.
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Affiliation(s)
- M Matilde M Spósito
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
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Carruthers JA, Lowe NJ, Menter MA, Gibson J, Nordquist M, Mordaunt J, Walker P, Eadie N. 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 2002; 46:840-9. [PMID: 12063480 DOI: 10.1067/mjd.2002.121356] [Citation(s) in RCA: 336] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Botulinum toxin type A (BTX-A) is widely used for facial esthetics but is incompletely studied. OBJECTIVE This study was conducted to evaluate the efficacy and safety of BTX-A treatment of glabellar lines. METHODS Patients with moderate to severe glabellar lines at maximum frown received intramuscular injections of 20 U BTX-A (BOTOX, Allergan, Inc, Irvine, Calif) or placebo into 5 glabellar sites. Patients were followed up for 120 days after injection. Outcome measures were physician rating of glabellar line severity at maximum frown and rest, patient assessment of improvement, and vital sign and adverse event monitoring. RESULTS Two hundred sixty-four patients were enrolled (BTX-A: 203, placebo: 61). There was a significantly greater reduction in glabellar line severity with BTX-A than with placebo (all measures, every follow-up visit; P <.022). The effect was maintained for many patients through day 120. There was a low occurrence (5.4%) of mostly mild blepharoptosis in the BTX-A group. CONCLUSION BTX-A injections are safe and effective in reducing the severity of glabellar lines.
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Träisk F, Tallstedt L. Thyroid associated ophthalmopathy: botulinum toxin A in the treatment of upper eyelid retraction--a pilot study. ACTA OPHTHALMOLOGICA SCANDINAVICA 2001; 79:585-8. [PMID: 11782224 DOI: 10.1034/j.1600-0420.2001.790608.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Eyelid retraction in patients with thyroid associated ophthalmopathy is a common cause of eye discomfort and a disfigured facial appearance. The aim of this pilot study was to evaluate the effects and safety of inducing a temporary partial ptosis of the eyelid through injection of botulinum toxin A into the levator palpebrae superioris muscle. METHODS Nine patients were treated. They were followed up with ophthalmologic examinations and self-assessment questionnaires until the point at which they either required renewed treatment or had no residual effect of the first injection. Maximum follow-up time was twenty weeks. RESULTS In all eyes but one there was a lowering of the eyelid position one week after treatment and all these patients reported an improvement of eye appearance and symptoms. There was variability in the degree of lowering of the eyelid with the same dose of injected botulinum toxin A. It was also difficult to predict the time interval needed for re-treatment. Ptosis impairing visual acuity was not a consequence of the treatment in any of the patients. One week after treatment two patients experienced increased diplopia but only one showed transient change in Lees screen measurement of eye motility. CONCLUSION Botulinum toxin A injection may be used to lower the upper eyelid position in patients awaiting eyelid surgery. The treatment safely relieved symptoms and improved eye appearance. However, treatment was short term and difficult to predict. There is also an inherent risk of transient diplopia.
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Affiliation(s)
- F Träisk
- St. Eriks Eye Hospital, Polhemsgatan 50, S-112 82 Stockholm, Sweden.
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Terwee CB, Dekker FW, Prummel MF, Wiersinga WM. Graves' ophthalmopathy through the eyes of the patient: A state of the art on health-related quality of life assessment. Orbit 2001; 20:281-290. [PMID: 12045905 DOI: 10.1076/orbi.20.4.281.2608] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The negative impact of the visual limitations and disfigurement associated with Graves' ophthalmopathy (GO) for a patient's daily life has always been acknowledged in clinical practice. However, only recently have the effects of GO on health-related quality of life (HRQL) been quantified using validated questionnaires. In this article, a state of the art is presented on the aims, methodology and application of HRQL assessment in GO research. HRQL assessment is important in cross-sectional studies aimed at describing the severity of GO on multiple outcome levels, including the impact of GO on patients' daily functioning and perception of health in general, and in longitudinal studies aimed at the evaluation of treatment efficacy or comparison of the effects of different treatments on HRQL. Only a few studies have measured the effects of GO on HRQL directly. Patients with GO have a relatively low HRQL, not only in the period that they are diagnosed and treated for the disease, but their low HRQL persists even many years after the final treatment. Because the current therapies for GO are primarily directed at improving (visual) functioning and appearance, these treatments should be evaluated for their effectiveness on HRQL outcomes. At the moment, the recently developed GO-QOL questionnaire is the only validated disease-specific instrument available to measure HRQL in patients with GO. The GO-QOL is recommended as an instrument to measure GO treatment effects on HRQL.
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Affiliation(s)
- C B. Terwee
- Institute for Research in Extramural Medicine, Free University of Amsterdam, The Netherlands
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Saks ND, Burnstine MA, Putterman AM. Glabellar rhytids in thyroid-associated orbitopathy. Ophthalmic Plast Reconstr Surg 2001; 17:91-5. [PMID: 11281597 DOI: 10.1097/00002341-200103000-00003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To correlate the presence and severity of glabellar rhytids with disease severity in patients with thyroid-associated orbitopathy (TAO). METHODS Retrospective, noncomparative medical record review of 113 consecutive new patient visits with the clinical diagnosis of TAO. Ocular examination features studied included assessment of visual acuity, optic nerve appearance and function, proptosis, strabismus, eyelid position, and exposure keratopathy. These features were correlated with graded clinical photographs evaluating rhytid severity using the Fisher exact text. RESULTS Eighty of 97 patients included in the study (82.5%) had glabellar rhytids. Eyelid retraction was present in 95 of the 97 patients (98%). Patients with diplopia had more severe rhytids (p < 0.05). Patients with at least three abnormal clinical findings tended to have more severe rhytids. CONCLUSIONS Glabellar rhytids are a common finding in patients with TAO, and tend to be present in patients with diplopia and multiple stigmata of the disease.
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Affiliation(s)
- N D Saks
- Department of Ophthalmology, Advocate Medical Group, Park Ridge, Illinois, USA
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Abstract
Graves' ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In mild cases, local therapeutic measures (artificial tears and ointments, sunglasses, nocturnal taping of the eyes, prisms) can control symptoms and signs. In severe forms of the disease (3-5%), aggressive measures are required. If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment. If the disease is severe but inactive, orbital decompression is preferred. Novel treatments such as somatostatin analogs or intravenous immunoglobulins are under evaluation. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease. Correction of both hyper- and hypothyroidism is crucial for the ophthalmopathy. Antithyroid drugs and thyroidectomy do not influence the course of the ophthalmopathy, whereas radioiodine treatment may cause the progression of preexisting ophthalmopathy, especially in smokers. The exacerbation, however, is prevented by glucocorticoids. In addition, thyroid ablation may prove beneficial for the ophthalmopathy in view of the pathogenetic model relating eye disease to autoimmune reactions directed against antigens shared by the thyroid and the orbit.
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Affiliation(s)
- L Bartalena
- Dipartimento di Endocrinologia e Metabolismo, Ortopedia e Traumatologia, Medicina del Lavoro, University of Pisa, Italy.
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Abstract
The surgical management of Graves ophthalmopathy includes treatment of globe malposition (exophthalmos), strabismus, and eyelid abnormalities. The various techniques used continue to be refined and are detailed in this review.
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Affiliation(s)
- D R Meyer
- Lions Eye Institute, Department of Ophthalmology, Albany Medical College, New York, USA
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