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Ferri A, Zito F, Menapace G, Zannoni C, Bergonzani M, Perlangeli G, Bianchi B. Optimizing the results of facial animation surgery: Botulinum toxin injection into free functional gracilis flap transfer. J Plast Reconstr Aesthet Surg 2023; 83:415-422. [PMID: 37307620 DOI: 10.1016/j.bjps.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/22/2023] [Accepted: 04/08/2023] [Indexed: 06/14/2023]
Abstract
Although neuromuscular gracilis transplantation is the best choice for facial reanimation in patients with congenital or inveterate palsy, the results are not completely satisfactory. Ancillary procedures developed to achieve better symmetry of the smile and reduce the hypercontractility of the transplanted muscle have been reported. However, the intramuscular injection of botulinum toxin has not been described for this purpose. Patients undergoing gracilis injections of botulinum toxin after facial reanimation surgery between September 1, 2020, and June 1, 2022, were retrospectively enrolled in this study. We collected photographs taken before and 20-30 days after injection and compared the symmetry of the face using software. Nine patients with a mean age of 23.56 years (range, 7-56 years) were enrolled. Reinnervation of the muscle was provided by the contralateral healthy facial nerve via a sural cross-graft (four patients), by the ipsilateral masseteric nerve (three cases), and by the contralateral masseteric and facial nerve (two). Using Emotrics software, we identified differences in the commissure excursion discrepancy of 3.82 mm, the smile angle discrepancy of 0.084°, and the dental show discrepancy of 1.49 mm; the average difference in the commissure height deviation was 2.26 mm (P = 0.02), and those in the upper- and lower-lip height deviation were 1.05 mm and 1.49 mm, respectively. Gracilis injection of botulinum toxin after gracilis transplantation is a safe and feasible procedure that could be applicable to all patients with asymmetric smiles related to excessive transplant contraction. It yields good esthetic results with little to no related morbidity.
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Affiliation(s)
- Andrea Ferri
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Francesca Zito
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy.
| | - Giorgia Menapace
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Cecilia Zannoni
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Michela Bergonzani
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Giuseppe Perlangeli
- Operative Unite of Maxillo-facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Bernardo Bianchi
- Operative Unite of Maxillo-facial Surgery, Hospital of Genova, Parma, Italy
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Scala J, Vojvodic A, Vojvodic P, Vlaskovic-Jovicevic T, Peric-Hajzler Z, Matovic D, Dimitrijevic S, Vojvodic J, Sijan G, Stepic N, Wollina U, Tirant M, Thuong NV, Fioranelli M, Lotti T. Botulin Toxin Use in Rosacea and Facial Flushing Treatment. Open Access Maced J Med Sci 2019; 7:2985-2987. [PMID: 31850105 PMCID: PMC6910814 DOI: 10.3889/oamjms.2019.784] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/06/2019] [Accepted: 07/07/2019] [Indexed: 12/24/2022] Open
Abstract
Botulinum toxin (BTX) is a neurotoxin derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction level whose effects has been used for many years to treat a variety of muscular/neuromuscular conditions and more recently also for cosmetic use. BTX has experimented in some dermatological conditions, which include Rosacea and facial flushing treatment with good results. The complex mechanism underlying those results is not completely understood but was proposed a release inhibition of acetylcholine from peripheral autonomic nerves of the cutaneous vasodilatory system combined with the blockade substance P and calcitonin gene-related peptide (CGRP) thus modulating blood vessel dilatation. We analysed the published data on BTX off label applications rosacea and flushing retrieved from PubMed.
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Affiliation(s)
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy, Belgrade, Serbia
| | - Petar Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | | | | | | | | | - Jovana Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | - Goran Sijan
- Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Nenad Stepic
- Chief of Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | | | - Nguyen Van Thuong
- Vietnam National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Massimo Fioranelli
- Department of Nuclear Physics, Sub-nuclear and Radiation, G. Marconi University, Rome, Italy
| | - Torello Lotti
- Department of Dermatology, University of G. Marconi, Rome, Italy
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Scala J, Vojvodic A, Vojvodic P, Vlaskovic-Jovicevic T, Peric-Hajzler Z, Matovic D, Dimitrijevic S, Vojvodic J, Sijan G, Stepic N, Wollina U, Tirant M, Thuong NV, Fioranelli M, Lotti T. Botulin Toxin Use in Scars/Keloids Treatment. Open Access Maced J Med Sci 2019; 7:2979-2981. [PMID: 31850103 PMCID: PMC6910812 DOI: 10.3889/oamjms.2019.783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/06/2019] [Accepted: 07/07/2019] [Indexed: 12/27/2022] Open
Abstract
Botulinum toxin (BTX) is a neurotoxin protein derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction level whose effects has been used for many years to treat a variety of muscular/neuromuscular conditions and more recently also for cosmetic use. BTX has experimented in some dermatological conditions which include scar prevention and treatment with good results The complex mechanism underlying those results is not completely understood but several mechanisms were proposed release inhibition of different substances like (TGF)-β, substance P, calcitonin gene-related peptide (CGRP) and glutamate thus modulating cutaneous inflammation and wound healing. We analysed the published data on BTX off label applications on scars and keloids retrieved from PubMed.
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Affiliation(s)
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy, Belgrade, Serbia
| | - Petar Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | | | | | | | | | - Jovana Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | - Goran Sijan
- Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Nenad Stepic
- Chief of Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | | | - Nguyen Van Thuong
- Vietnam National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Massimo Fioranelli
- Department of Nuclear Physics, Sub-nuclear and Radiation, G. Marconi University, Rome, Italy
| | - Torello Lotti
- Department of Dermatology, University of G. Marconi, Rome, Italy
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Bueno-Lledó J, Torregrosa Gallud A, Jiménez Rosellón R, Carbonell Tatay F, García Pastor P, Bonafé Diana S, Iserte Hernández J. Preoperative preparation of «loss of domain» hernia. Progressive pneumoperitoneum and botulinum toxin type A. Cir Esp 2017; 95:245-253. [PMID: 28554686 DOI: 10.1016/j.ciresp.2017.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/25/2017] [Accepted: 04/25/2017] [Indexed: 11/19/2022]
Abstract
Preoperative progressive pneumoperitoneum and botulinum toxin type A are useful tools in the preparation of patients with loss of domain hernias. Both procedures are complementary in the surgical repair, especially with the use of prosthetic techniques without tension, that allow a integral management of these patients. The aim of this paper is to update concepts related to both procedures, emphasizing the advantages that take place in the preoperative management of loss of domain hernias.
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Affiliation(s)
- José Bueno-Lledó
- Unidad de Cirugía de Pared Abdominal, Departamento de Cirugía Digestiva, Hospital Universitari i Politecnic La Fe, Universidad de Valencia, Valencia, España.
| | - Antonio Torregrosa Gallud
- Unidad de Cirugía de Pared Abdominal, Departamento de Cirugía Digestiva, Hospital Universitari i Politecnic La Fe, Universidad de Valencia, Valencia, España
| | - Raquel Jiménez Rosellón
- Unidad de Cirugía de Pared Abdominal, Departamento de Cirugía Digestiva, Hospital Universitari i Politecnic La Fe, Universidad de Valencia, Valencia, España
| | | | - Providencia García Pastor
- Unidad de Cirugía de Pared Abdominal, Departamento de Cirugía Digestiva, Hospital Universitari i Politecnic La Fe, Universidad de Valencia, Valencia, España
| | - Santiago Bonafé Diana
- Unidad de Cirugía de Pared Abdominal, Departamento de Cirugía Digestiva, Hospital Universitari i Politecnic La Fe, Universidad de Valencia, Valencia, España
| | - José Iserte Hernández
- Unidad de Cirugía de Pared Abdominal, Departamento de Cirugía Digestiva, Hospital Universitari i Politecnic La Fe, Universidad de Valencia, Valencia, España
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Esposito D, Maione F, D’Alessandro A, Sarnelli G, De Palma GD. Endoscopic treatment of esophageal achalasia. World J Gastrointest Endosc 2016; 8:30-39. [PMID: 26839644 PMCID: PMC4724029 DOI: 10.4253/wjge.v8.i2.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/19/2015] [Accepted: 12/15/2015] [Indexed: 02/05/2023] Open
Abstract
Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type II achalasia are better after treatment compared to younger patients, males and type III achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies.
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Revuelta-Gutiérrez R, Velasco-Torres HS, Vales Hidalgo LO, Martínez-Anda JJ. [Painful tic convulsif: Case series and literature review]. CIR CIR 2016; 84:493-498. [PMID: 26774197 DOI: 10.1016/j.circir.2015.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The coexistence of hemifacial spasm and trigeminal neuralgia, a clinical entity known as painful tic convulsive, was first described in 1910. It is an uncommon condition that is worthy of interest in neurosurgical practice, because of its common pathophysiology mechanism: Neuro-vascular compression in most of the cases. OBJECTIVE To present 2 cases of painful tic convulsive that received treatment at our institution, and to give a brief review of the existing literature related to this. The benefits of micro-surgical decompression and the most common medical therapy used (botulin toxin) are also presented. CLINICAL CASES Two cases of typical painful tic convulsive are described, showing representative slices of magnetic resonance imaging corresponding to the aetiology of each case, as well as a description of the surgical technique employed in our institution. The immediate relief of symptomatology, and the clinical condition at one-year follow-up in each case is described. A brief review of the literature on this condition is presented. CONCLUSION This very rare neurological entity represents less than 1% of rhizopathies and in a large proportion of cases it is caused by vascular compression, attributed to an aberrant dolichoectatic course of the vertebro-basilar complex. The standard modality of treatment is micro-vascular surgical decompression, which has shown greater effectiveness and control of symptoms in the long-term. However medical treatment, which includes percutaneous infiltration of botulinum toxin, has produced similar results at medium-term in the control of each individual clinical manifestation, but it must be considered as an alternative in the choice of treatment.
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Affiliation(s)
- Rogelio Revuelta-Gutiérrez
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - Héctor Sebastián Velasco-Torres
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México.
| | - Lourdes Olivia Vales Hidalgo
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - Jaime Jesús Martínez-Anda
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
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