Effect of Botulinum Toxin A on Muscle Healing and its Implications in Aesthetic and Reconstructive Surgery

Silberstein, Eldad; Maor, Ehud; Sukmanov, Oleg; Berezovsky, Alexander Bogdanov; Shoham, Yaron; Krieger, Yuval

doi:10.1093/asj/sjx207

Cited by 6 publications

(3 citation statements)

References 12 publications

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“…One of the reasons for the latter is that the installed fibrous tissue after HNSCC is the major factor contributing to chronic trismus, especially for more severe trismus cases [39]. This was supported by the fact that all but one of the included articles described the simultaneous muscle healing, thus contributing to a more successful long-term result [40]. Subgroup analysis of the primary treatment revealed that a higher gain in MMO is to be expected after trismus release if no primary resection was performed, which can be attributed to fibrous scar tissue formation after primary surgery.…”

Section: Discussionmentioning

confidence: 98%

The Effectiveness of Surgical Methods for Trismus Release at Least 6 Months After Head and Neck Cancer Treatment: Systematic Review

Smeets

Croonenborghs

Dessel

et al. 2022

Front. Oral. Health

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BackgroundThe objective of this systematic review was to identify the different surgical treatment modalities of severe trismus after head and neck squamous cell cancer treatment.MethodsAn electronic literature database search was conducted in Medline, Embase, Cochrane, Web of Science, and OpenGrey to determine articles published up to September 2021. Two observers independently assessed the identified papers for eligibility according to PRISMA guidelines. The inclusion criteria were trismus after head and neck squamous cell cancer with consecutive treatment, detailed description of the surgical procedure for trismus release, description of the initial treatment, at least 6 months between initial cancer treatment and trismus release surgery, a minimal follow-up (FU) of 6 months, and availability of full text. The quality was evaluated using the Newcastle-Ottawa scale. A subanalysis of the maximal mouth opening (MMO) was performed using a mixed-effect model.ResultsA total of 8,607 unique articles were screened for eligibility, 69 full texts were reviewed, and 3 studies, with a total of 46 cases, were selected based on the predetermined inclusion and exclusion criteria. Three treatment strategies were identified for trismus release (1) free flap reconstruction (FFR), (2) coronoidectomy (CN), and (3) myotomy (MT). There was a clear improvement for all treatment modalities. A quantitative analysis showed a beneficial effect of CN (mean 24.02 ± 15.02 mm) in comparison with FFR (mean 19.88 ± 13.97 mm) and MT (mean 18.38 ± 13.22 mm) (P < 0.01*). An increased gain in MMO after trismus release was found if no primary resection was performed (P = 0.014*). Two studies included in the analysis had an intermediate risk of bias and one had a low risk of bias.ConclusionCurrently available reports suggest a low threshold for performing a CN compared with FFR and MT. There is a need for high-quality randomized controlled trials with carefully selected and standardized outcome measures.

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Section: Discussionmentioning

confidence: 98%

The Effectiveness of Surgical Methods for Trismus Release at Least 6 Months After Head and Neck Cancer Treatment: Systematic Review

Smeets

Croonenborghs

Dessel

et al. 2022

Front. Oral. Health

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“…On the other hand, a recent study showed that BTX-A injection into the muscle immediately after myotomy interfered with the process of muscle healing, which may contribute to more successful outcomes of myotomy. 30 Intraoperative BTX-A injection into the residual muscle of Riolan may reduce the risk of regeneration of the muscle activity more reliably.…”

Section: Discussionmentioning

confidence: 99%

Disabling muscle of Riolan: A novel concept of orbicularis oculi myectomy for refractory benign essential blepharospasm

Takahashi

Vaidya

Lee

et al. 2021

European Journal of Ophthalmology

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Purpose: To examine the effectiveness of orbicularis oculi myectomy with disabling the muscle of Riolan in patients with benign essential blepharospasm refractory to botulinum toxin-A (BTX-A) injection. Methods: This retrospective, observational study included 25 patients. After removal of the redundant skin and underlying orbicularis oculi muscle (OOM) with or without extended OOM removal to the area of the superior orbital rim, the tarsal plate and the gray line were vertically severed at 2 points to disable the muscle of Riolan. The surgical effectiveness was evaluated using the visual analogue scale (VAS), functional disability score (FDS), and the presence or absence of necessity or enhanced effectiveness of BTX-A injection after surgery. Results: The symptoms improved in 23 patients (92.0%). The VAS and total FDS were significantly improved from 8.4 ± 1.7 to 4.0 ± 2.4 (reduction rate, 50.7 ± 35.6%) and from 74.6 ± 22.2 to 34.7 ± 25.3 (reduction rate, 53.4 ± 27.4%) after surgery, respectively (both, p < 0.001). Among the 23 patients whose symptoms improved after surgery, BTX-A injection was not required in 11 of them (47.8%). Among the remaining 12 patients (52.2%), the effectiveness of BTX-A was post-operatively enhanced in eight patients (34.8%). There were no serious complications, and none of the patients experienced madarosis. Conclusion: Disabling the muscle of Riolan is a valuable option of OOM myectomy in patients with refractory benign essential blepharospasm, without the development of serious complications, including madarosis.

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“…According to their study, administering botulinum toxin A into a muscle immediately after myotomy could disrupt muscle healing and improve the long-term outcome. It is observed that higher gains in MIO are expected after trismus release when no primary resection was performed [106]. This can be attributed to the formation of fibrous scar tissue following primary surgery.…”

Section: Recurrent Trismusmentioning

confidence: 99%

Treatment Complications of Head and Neck Cancers and Rehabilitation Measures: A Narrative Review

Sharma,

Kumar Upadhyay,

Prakash

et al. 2024

Cureus

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Head and neck cancers (HNCs) are malignant tumors mainly from squamous cells in the head and neck tissues. Treatment involves a multidisciplinary approach with surgery, radiotherapy, and chemotherapy. However, the long-term prognosis for patients with advanced-stage tumors is guarded, with a median survival time of approximately 24 months. HNC patients have very high rates of depression and anxiety and the highest suicide rate among all cancers due to the intense and challenging nature of the treatment, underscoring the importance of our collective efforts. Rehabilitation success depends on various factors, including tumor, patient, and treatment-related factors. Patients may require post-treatment oral rehabilitation measures, including implants, obturators, and flexible dentures. These measures are crucial, but they often need to be more utilized. Patients may face challenges in maintaining oral hygiene and managing mucositis. Additionally, it is essential to address other intricacies such as trismus, xerostomia, gustatory dysfunctions, neuropathy, speech impairments, and psychological disturbances. Unfortunately, there is little literature on post-treatment rehabilitative measures. Despite its crucial role in improving patients' quality of life, rehabilitation often receives inadequate attention compared to treatment. Our narrative review, which covers various factors that affect rehabilitation, including oral rehabilitation measures and post-treatment complications, is anticipated to deliver practical insights to professionals and inspire positive changes in their regular practice.

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Effect of Botulinum Toxin A on Muscle Healing and its Implications in Aesthetic and Reconstructive Surgery

Abstract: Addition of BtxA injection into a muscle immediately after myotomy may interfere with muscle healing and contribute to a more successful long-term result.

Cited by 6 publications

References 12 publications

The Effectiveness of Surgical Methods for Trismus Release at Least 6 Months After Head and Neck Cancer Treatment: Systematic Review

The Effectiveness of Surgical Methods for Trismus Release at Least 6 Months After Head and Neck Cancer Treatment: Systematic Review

Disabling muscle of Riolan: A novel concept of orbicularis oculi myectomy for refractory benign essential blepharospasm

Treatment Complications of Head and Neck Cancers and Rehabilitation Measures: A Narrative Review

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