Inadvertent subretinal injection of botulinum toxin

Sánchez-Ramos, Jorge Arturo; Díaz-Benítez, Ezequiel; Hernández-Vázquez, Ángeles Yahel; Pérez-Montaño, Carla Rocío; Rojas-Juárez, Sergio; Ramírez-Estudillo, Juan Abel; Zavaleta-Herrera, Fernando

doi:10.24875/rmoe.m19000067

RMOE

2019

DOI: 10.24875/rmoe.m19000067

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Inadvertent subretinal injection of botulinum toxin

Jorge Arturo Sánchez-Ramos¹,

Ezequiel Díaz-Benítez²,

Ángeles Yahel Hernández-Vázquez³

et al.

Abstract: Case Report: This is a 19-year-old male with bilateral external rectus muscle palsy secundary to trauma. During treatment, an inadvertent intraocular injection of botulinum toxin was present, causing a retinal tear and localized retinal detachment. Both lesions were delimited with laser observing a spontaneous resolution of the detachment without presenting visual impairment during the follow-up. Discussion: Although intraocular botulinum toxin does not generate retinal toxicity, inadvertent intraocular inject… Show more

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2023

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“…22 Furthermore, intraocular injection and retinal damage have been reported in the treatment of hemifacial spasm and when targeting the periocular muscles adjacent to the lacrimal gland. [23][24][25][26][27][28][29] These complications should be avoidable with higher injection precision. However, this has not been proven.…”

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confidence: 99%

Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors

Kildal

Rodríguez-Lorenzo

Pruidze

et al. 2023

Plastic &Amp; Reconstructive Surgery

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otulinum toxin injection is the accepted standard treatment for facial synkinesis and gustatory hyperlacrimation, two common and disabling sequelae of facial paralysis. Synkinesis, the involuntary movement of facial muscles occurring when other facial muscles are moved voluntarily, 1 leads to functional and social problems. 2 Gustatory hyperlacrimation (commonly known as crocodile tears syndrome), that is, excessive tear production when eating and Background: Botulinum toxin injection is the accepted standard treatment for synkinesis and gustatory hyperlacrimation in patients with facial paralysis. However, poor injection accuracy can result in inconsistent treatment outcomes, variable treatment durations, and complications. Ultrasound guidance should increase injection accuracy in the facial region; however, this has not been proven. Methods: Twenty-six hemifaces of nonembalmed cadavers were studied in a randomized split-face manner. Ink was injected with ultrasound or landmark guidance into the lacrimal gland and three common synkinetic muscles: the orbicularis oculi, depressor anguli oris, and mentalis. Injection accuracy was evaluated using several measures. Results: Using ultrasound guidance, most ink (>50%) was found inside the correct target in 88% of cases, compared with 50% using landmark guidance (P < 0.001). This was most pronounced in the lacrimal gland (62% versus 8%), depressor anguli oris (100% versus 46%), and mentalis (100% versus 54%) (P < 0.05). All ink was found inside the correct target (no ink outside) in 65% using ultrasound guidance versus 29% without (P < 0.001). Injection accuracy (any ink in target) was 100% when using ultrasound guidance versus 83% without (P < 0.01). Twenty-three percent of the landmark-guided depressor anguli oris injections stained the facial artery (P = 0.22). Conclusions: Ultrasound guidance significantly increased injection accuracy and reduced the amount of ink lost in the surrounding tissue compared with landmark guidance. Clinical trials are needed to explore the effects of ultrasound guidance on treatment outcome, duration, and complications in patients with facial paralysis.

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mentioning

confidence: 99%

Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors

Kildal

Rodríguez-Lorenzo

Pruidze

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Inadvertent subretinal injection of botulinum toxin

Cited by 1 publication

References 6 publications

Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors

Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors

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