Department of Otorhinolaryngology, Inje University College of Medicine, Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea.
Otol Neurotol. 2013 Feb;34(2):319-24. doi: 10.1097/mao.0b013e31827c9f58.
The application of botulinum toxin to the healthy side of the face in patients with long-standing facial paralysis has been shown to be a minimally invasive technique that improves facial symmetry at rest and during facial motion, but our experience using botulinum toxin therapy for facial sequelae prompted the idea that botulinum toxin might be useful in acute cases of facial paralysis, leading to improve facial asymmetry.
In cases in which medical or surgical treatment options are limited because of existing medical problems or advanced age, most patients with acute facial palsy are advised to await spontaneous recovery or are informed that no effective intervention exists. The purpose of this study was to evaluate the effect of botulinum toxin treatment for facial asymmetry in 18 patients after acute facial palsy who could not be optimally treated by medical or surgical management because of severe medical or other problems.
From 2009 to 2011, nine patients with Bell's palsy, 5 with herpes zoster oticus and 4 with traumatic facial palsy (10 men and 8 women; age range, 22-82 yr; mean, 50.8 yr) participated in this study. Botulinum toxin A (Botox; Allergan Incorporated, Irvine, CA, USA) was injected using a tuberculin syringe with a 27-gauge needle. The amount injected per site varied from 2.5 to 3 U, and the total dose used per patient was 32 to 68 U (mean, 47.5 +/- 8.4 U).
After administration of a single dose of botulinum toxin A on the nonparalyzed side of 18 patients with acute facial paralysis, marked relief of facial asymmetry was observed in 8 patients within 1 month of injection. Decreased facial asymmetry and strengthened facial function on the paralyzed side led to an increased HB and SB grade within 6 months after injection.
Use of botulinum toxin after acute facial palsy cases is of great value. Such therapy decreases the relative hyperkinesis contralateral to the paralysis, leading to greater symmetric function. Especially in patients with medical problems that limit the medical or surgical treatment options, botulinum toxin therapy represents a useful alternative.
在患有长期面瘫的患者的健侧面部应用肉毒毒素已被证明是一种微创技术，可改善面部静止和运动时的对称性，但我们使用肉毒毒素治疗面瘫后遗症的经验促使我们认为肉毒毒素可能对急性面瘫病例有用，可以改善面部不对称。
在由于现有医疗问题或高龄而导致医疗或手术治疗选择有限的情况下，大多数急性面瘫患者被建议等待自发恢复，或被告知没有有效的干预措施。本研究的目的是评估肉毒毒素治疗 18 例因严重医疗或其他问题而无法通过药物或手术治疗而得到最佳治疗的急性面瘫患者的面部不对称的效果。
2009 年至 2011 年，9 例贝尔麻痹患者、5 例带状疱疹性耳炎患者和 4 例创伤性面瘫患者（10 例男性和 8 例女性；年龄 22-82 岁；平均年龄 50.8 岁）参与了本研究。使用结核菌素注射器和 27 号针头注射肉毒毒素 A（Botox；Allergan Incorporated，Irvine，CA，USA）。每个部位的注射量从 2.5 到 3U 不等，每位患者的总剂量为 32 到 68U（平均 47.5 +/- 8.4U）。
在 18 例急性面瘫患者的健侧单次注射肉毒毒素 A 后，8 例患者在注射后 1 个月内观察到面部不对称明显缓解。注射后 6 个月内，患侧面部的面部不对称减轻和面部功能增强导致 HB 和 SB 分级增加。
急性面瘫后使用肉毒毒素具有重要价值。这种治疗方法可减少麻痹对侧的相对运动亢进，从而使功能更加对称。特别是在那些限制医疗或手术治疗选择的医疗问题的患者中，肉毒毒素治疗代表了一种有用的替代方法。
