RESUMO

A sociedade está cada vez mais exigente e em busca de excelência quando o assunto é estética facial. O sorriso tem grande impacto na harmonia da face e, atualmente, os pacientes estão mais conscientes sobre a influência da gengiva na beleza do sorriso. A exposição da gengiva em excesso, conhecida como sorriso gengival, afeta a estética, podendo interferir na autoestima e nas relações sociais dos pacientes. Existem diversos procedimentos descritos para solucionar o problema e, para o planejamento do caso e escolha do método, é preciso determinar a etiologia e levar em consideração o desejo do paciente. A injeção da proteína botulínica é uma alternativa minimamente invasiva que está sedo cada vez mais utilizada para a correção do sorriso gengival. Com isso, o objetivo do presente trabalho monográfico foi realizar uma revisão de literatura sobre o uso da toxina botulínica na correção do sorriso gengival, analisando técnicas de injeção, identificando o efeito imediato e a longo prazo da toxina nos músculos elevadores do lábio superior, além de avaliar a relevância desse método na correção do sorriso gengival, sozinho ou em conjunto com outros procedimentos. Foi realizada uma revisão de literatura nas bases de dados PubMed e Scielo, buscando artigos dos anos de 2013 até 2022, utilizando os descritores "botulinum toxin", "botox", "gummy smile", "gingival display" e "gingival exposure". Essa revisão analisa 15 artigos que discorrem sobre o método, durabilidade e eficácia da aplicação de proteína botulínica para correção do sorriso gengival. Algumas variantes diferenciam as técnicas de aplicação, como a marca do produto e recomendações do fabricante, classificação do sorriso e extensão da exposição gengival. Com base na revisão de literatura, pôde-se concluir que, apesar de ser transitório, esse procedimento se mostrou eficaz, tanto ao ser realizado como método principal, quanto como coadjuvante no tratamento. Além de ser comprovadamente seguro, rápido, minimamente invasivo e ser o tratamento de preferência entre os pacientes, com alto índice de satisfação, são raras as complicações relacionadas a aplicação da proteína botulínica para esse fim.

Society is becoming increasingly demanding, seeking excellence in facial aesthetics. The smile greatly impacts facial harmony, and nowadays, patients are more aware of the influence of the gums on smile beauty. Excessive gum exposure, known as gummy smile, affects aesthetics and can interfere with patients' self-esteem and social relationships. There are various procedures described to address this issue, and for case planning and method selection, it is necessary to determine the etiology and take into account the patient's desires. The injection of botulinum protein is a minimally invasive alternative that is increasingly being used for gummy smile correction. Thus, the aim of this monographic work was to conduct a literature review on the use of botulinum toxin in gummy smile correction, analyzing injection techniques, identifying the immediate and long-term effects of the toxin on the upper lip elevator muscles, and evaluating the relevance of this method in gummy smile correction, either alone or in conjunction with other procedures. A literature review was conducted in the PubMed and Scielo databases, seeking articles from 2013 to 2022, using the descriptors "botulinum toxin", "botox", "gummy smile", "gingival display", and "gingival exposure". This review analyzes 15 articles that discuss the method, durability, and effectiveness of botulinum toxin application for gummy smile correction. Some variations differentiate the application techniques, such as the product brand and manufacturer's recommendations, smile classification, and extent of gum exposure. Based on the literature review, it was possible to conclude that, despite being temporary, this procedure proved to be effective, both when performed as the main method and as an adjunct in treatment. In addition to being proven safe, fast, minimally invasive, and the preferred treatment among patients, with a high satisfaction rate, complications related to botulinum toxin application for this purpose are rare.

Assuntos

RESUMO

BACKGROUND: Botulinum Toxin (BoNTA) is the most used nonsurgical aesthetic procedure to treat facial expression lines. AIMS: This study compared the efficacy of Prabotulinum toxin-A, a novel BoNTA that originates from Clostridium botulinum Hall-A, with onabotulinum toxin-A in treating facial expression lines using the Facial Wrinkle Scale (FWS) and FACE-Q questionnaires. METHODS: This was an experimental, comparative, longitudinal, open-label, and prospective study. Patients aged between 25 and 40 years with upper-third facial expression lines were included. Follow-ups were made at three, seven, 30, and 120 days. RESULTS: A total of 26 patients were included: 20 female, and six males, with a mean age of 28.26 years. An average of 31.00 IU and 31.38 IU were administered to the onabotulinum and prabotulinum groups, respectively. The prabotulinum group demonstrated superiority in FWS and Face-Q scores between the first and third days (p ≤ 0.001, p < 0.001, respectively), which continued on day 7. By day 30, there were no differences in the scores of the two questionnaires. CONCLUSIONS: Prabotulinum toxin-A is a safe and effective treatment for upper-third facial wrinkles. On day three and seven, the results suggest that prabotulinum toxin-A has a quicker onset of action than onabotulinum toxin-A. On days 30 and 120, both groups showed similar FWS and Face-Q scores.

RESUMO

Botulinum toxin type A (BTA) injection, marketed as BOTOX, is commonly used as a treatment for a variety of clinical indications and is widely viewed as safe, effective and largely devoid of serious side effects. Anaphylactic reactions to BTA are typically unheard of in the scientific literature. BOTOX is approved by the Food and Drug Administration for the treatment of cervical dystonia and prophylaxis for chronic migraines. This case report documents a unique instance of allergic reaction to BTA in a 29-year-old woman with cervicogenic headache and cervical dystonia who reported immediate flushing, light-headedness and nausea after receiving BTA injections.

A injeção de toxina botulínica tipo A (BTA), comercializada como BOTOX, é comumente usada como tratamento para uma variedade de indicações clínicas e é amplamente considerada segura, eficaz e amplamente desprovida de efeitos colaterais graves. As reações anafiláticas ao BTA são normalmente inéditas na literatura científica. BOTOX é aprovado pela Food and Drug Administration para o tratamento de distonia cervical e profilaxia de enxaquecas crônicas. Este relato de caso documenta um caso único de reação alérgica ao BTA em uma mulher de 29 anos com dor de cabeça cervicogênica e distonia cervical que relatou rubor imediato, tontura e náusea após receber injeções de BTA.

RESUMO

Improvements in Botulinum toxin type-A (BoNT-A) aesthetic treatments have been jeopardized by the simplistic statement: "BoNT-A treats wrinkles". BoNT-A monotherapy relating to wrinkles is, at least, questionable. The BoNT-A mechanism of action is presynaptic cholinergic nerve terminals blockage, causing paralysis and subsequent muscle atrophy. Understanding the real BoNT-A mechanism of action clarifies misconceptions that impact the way scientific productions on the subject are designed, the way aesthetics treatments are proposed, and how limited the results are when the focus is only on wrinkle softening. We designed a systematic review on BoNT-A and muscle atrophy that could enlighten new approaches for aesthetics purposes. A systematic review, targeting articles investigating BoNT-A injection and its correlation to muscle atrophy in animals or humans, filtered 30 publications released before 15 May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Histologic analysis and histochemistry showed muscle atrophy with fibrosis, necrosis, and an increase in the number of perimysial fat cells in animal and human models; this was also confirmed by imaging studies. A significant muscle balance reduction of 18% to 60% after single or seriated BoNT-A injections were observed in 9 out of 10 animal studies. Genetic alterations related to muscle atrophy were analyzed by five studies and showed how much impact a single BoNT-A injection can cause on a molecular basis. Seriated or single BoNT-A muscle injections can cause real muscle atrophy on a short or long-term basis, in animal models and in humans. Theoretically, muscular architecture reprogramming is a possible new approach in aesthetics.

Assuntos

RESUMO

The use of botulinum neurotoxin-A (BoNT-A) is an alternative for the management of orofacial pain disorders. Although only Botox has labeled, there are other commercial brands available for use, among them: Dysport, Botulift, Prosigne, and Xeomin. The objective of the present study was to evaluate the possible differences in the antinociceptive effect evoked by different commercially available formulations of BoNT-A in an animal model of inflammatory orofacial pain induced by formalin injection. Male C57/BL6 mice (20-25 g) were submitted to the pre-treatment with five different commercial brands of BoNT-A (Botox, Botulift, Xeomin, Dysport, or Prosigne; with doses between 0.02 and 0.2 Units of Botulinum Toxin, in 20 µL of 0.9% saline) three days prior the 2% formalin injection. All injections were made subcutaneously into the right perinasal area. After formalin injections, nociceptive behaviors like rubbing the place of injection were quantified during the neurogenic (0-5 min) and inflammatory (15-30 min) phases. The treatment using Botox, Botulift, and Xeomin were able to induce antinociceptive effects in both phases of the formalin-induced pain animal model, however, Dysport and Prosigne reduced the response in neither of them. Our data suggest that the treatment using different formulations of BoNT-A is not similar in efficacy as analgesics when evaluated in formalin-induced orofacial pain in mice.

RESUMO

Injection of soft tissue fillers for esthetic purposes is considered a relatively simple, minimally invasive procedure. Although rare, significant complications exist and may occur in the setting of both non-medical grade and medical-grade silicone fillers, administered by untrained or trained providers. We report a case of a 61 y/o male with an unusual case of foreign body granulomas arising on his forehead and periorbital region for the past 3 years. He had no drug allergies or history of trauma. He only recalled administration of "Botox" near the affected area 20 years ago, although he acknowledged being unsure of the nature of the substance. Examination showed bilateral, periorbital, edematous plaques, with subcutaneous nodules on the forehead. Punch biopsy showed multiple vacuoles surrounded by collagen bundles in the dermis, a histiocytic infiltrate, and multinucleated giant cells. Based on clinicopathological correlation, a diagnosis of foreign body granuloma related to silicone filler injections was made. He was treated with intralesional steroids and doxycycline 100 mg twice daily with complete resolution. Physicians should acknowledge this potential complication of silicone fillers and should inquire about their use with close-ended questions. We also review the diagnostic and therapeutic challenges faced by physicians when encountering this diagnosis.

Assuntos

RESUMO

Purpose of Review: This review will cover seminal and emerging evidence on interventional therapy chronic pain in cerebral palsy (CP). It will cover the background and burden of disease, present the current options, and then weigh the evidence that is available to support interventional therapy and the current indications. Recent Findings: CP is a permanent posture and movement disorder from in-utero brain development defects with a 3-4/1,000 incidence in the US. The cost of care for each child is estimated at $921,000. Pain in CP is attributed to musculoskeletal deformities, spasticity, increased muscle tone, dislocations, and GI dysfunction. First-line treatments include physical and occupational therapy and oral pharmacological agents; however, a significant amount of patients remain refractory to these and require further therapy. Injection therapy includes botulinum toxin A (BTA) injections and intrathecal baclofen. BTA injections were shown to control chronic pain effectively and are FDA approved for spastic pain; intra-thecal baclofen, in contrast, was only shown to improve comfort and quality of life with a focus on the pain. Surgical intervention includes selection dorsal rhizotomy (SDR). It may increase range of motion and quality of life and reduce spasticity and pain; however, most evidence is anecdotal, and more research is required. Summary: Interventional therapy, including injection and surgical, is the last line of therapy for chronic pain in CP. It extends the possibility of therapy in hard-to-treat individuals; however, more data is required to provide strong evidence to the efficacy of these treatments and guide proper patient selection.

Assuntos

RESUMO

Therapeutic botulinum toxin injections are commonly performed in pediatric otolaryngology. Aerodigestive complications from botulinum toxin injections, although rare, may be serious. Oral pyridostigmine is effective in the symptomatic treatment of these complications. We report 2 cases of aerodigestive complications arising from injection of botulinum toxin that were successfully treated with pyridostigmine.

Assuntos

RESUMO

Resumen: La parálisis facial altera la función muscular desencadenando diversas alteraciones funcionales, psicológicas, emocionales, estéticas y sociales. Existen múltiples causas y tratamientos quirúrgicos y no quirúrgicos para tratar el lado paralizado. Sin embargo, en pacientes con parálisis facial de larga evolución, en quienes el tratamiento quirúrgico ha generado mínimos beneficios o pacientes no candidatos a tratamientos quirúrgicos, el uso de toxina botulínica es una alternativa viable para tratar lado afectado cuando existen secuelas como sincinesias, hipertonía o espasmo hemifacial. En el lado no afectado también se utiliza para ocasionar simetría estética y funcional estática y dinámica. Se presenta un caso clínico de un paciente varón con parálisis facial idiopática derecha tratado con quimiodenervación contralateral selectiva con toxina botulínica y su evolución favorable hacia la funcionalidad y normalización de la simetría facial dinámica.

Abstract: By altering muscle function, facial palsy causes functional, psychological, emotional, aesthetic and social changes. There are several etiologies and multiple treatments to treat paralyzed side. However, patients with longstanding facial palsy, patients in whom surgical treatment has generated minimal benefits or patients who are not candidates for surgical treatments, the use of botulinum toxin is an adequate alternative to treat affected side when there are sequelae as sinkynesis, hypertony or hemifacial spasm. In the unaffected side is also used to cause static and dynamic aesthetic and functional symmetry. We present a male patient with right idiopathic facial palsy treated with selective contralateral chemodenervation with botulinum toxin. This treatment resulted in the patient's favorable evolution towards functionality and normalization of dynamic facial symmetry.

RESUMO

We report a case of mycobacterial infection at the sites of previous injections of botulinum toxin A in a 45-year-old woman. She presented with erythematous, swollen, warm, and tender plaques and nodules at the points of injection from which a biopsy was taken, demonstrating a deep dermal and hypodermal abscessified epithelioid granulomatous inflammatory infiltrate in which some acid-fast bacilli were identified with Ziehl-Neelsen and Fite-Faraco stains. The lesion was first treated with clarithromycin plus azithromycin, to which rifampicin was later added. A good therapeutic response was obtained.

RESUMO

A partir de los primeros usos terapéuticos de la toxina botulínica su utilización se ha extendido a variadas ramas de la medicina incluyendo la otorrinolaringología. Se considera un medicamento seguro en manos de profesionales capacitados y su utilización se realiza a través de un procedimiento mínimamente invasivo con efectos adversos leves y transitorios. Se usa en un amplio número de patologías otorrinolaringológicas y de cabeza y cuello. Actualmente la toxina botulínica A representa la primera línea de tratamiento en pacientes con disfonía espasmódica y distonía cervical. Existe evidencia de buen nivel que recomienda su uso para el manejo de sialorrea, temblor laríngeo, trastornos de la ATM, bruxismo y rinitis en casos seleccionados. Presenta buenos resultados en otras patologías como espasmo faringoesofágico, síndrome de Frey y tinnitus, sin embargo, todavía son necesarios más estudios.

Since the first therapeutic uses of botulinum toxin its role has extended to a wide range of medicine áreas including otolaryngology. It is considered a safe medication in the hands of trained professionals and its application represents a minimally invasive procedure with mild and transient adverse effects. It has been used in a wide range of otolaryngology and head and neck pathologies. Today botulinum toxin a represents the first choice of treatment for patients with spasmodic dysphonia and cervical dystonia. There is good evidence that supports its use for shialorrea, laryngeal tremor, temporomandibular joint disorders, bruxism and selected cases of rhinitis. For pharyngo-oesophageal spasm, Frey's syndrome and tinnitus there have been studies that show a beneficial effect however more studies are required for routine recommendation.

Assuntos

RESUMO

Urinary symptoms occur in 19% of human T-cell lymphotropic virus type 1 (HTLV-1)-infected patients who do not fulfill criteria for HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and in almost 100% of HAM/TSP patients. Few studies have evaluated therapies for overactive bladder (OAB) caused by HTLV-1 infection. This case report describes the effect of onabotulinum toxin A on the urinary manifestations of three patients with HAM/TSP and OAB symptoms. The patients were intravesically administered 200 units of Botox®. Their incontinence episodes improved, and their OAB symptoms scores (OABSS) reduced significantly. These data indicate that Botox® should be a treatment option for OAB associated with HTLV-1 infection.

Assuntos

RESUMO

Many of the patients with migraine require a preventive therapy to reduce frequency, severity and duration of the crisis, to improve the quality of life, and to improve the responsse to abortive theraphy of attacks. The treatment can be pharmacological, non pharmacological, or the combination of both. This article reviews the indications for the prophylaxis of migraine, the different drugs that are, their mechanisms of actions, their adverse effects therapeutic limitations, and cautions when combining the abortive and prophylactic therapy of migraine.

Muchos de los pacientes con migraña requieren un tratamiento preventivo, para disminuir la frecuencia, la intensidad y la duración de las crisis, mejorar la calidad de vida, y mejorar la respuesta a los tratamientos abortivos para los ataques. El tratamiento puede ser farmacológico, no farmacológico, o la combinación de ambos. En este artículo se revisan las indicaciones para la prevención de la migraña, los diferentes medicamentos que se utilizan, sus mecanismos de acción, efectos adversos y limitaciones terapéuticas, y las precauciones que se deben tener al combinar la terapia abortiva y preventivo de la migraña.

Assuntos