Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee.
Pi Beta Phi Rehabilitation Institute, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Facial Plast Surg. 2018 May 1;20(3):196-201. doi: 10.1001/jamafacial.2017.1385.
The buccinator, despite being a prominent midface muscle, has been previously overlooked as a target in the treatment of facial synkinesis with botulinum toxin.
To evaluate outcomes of patients treated with botulinum toxin to the buccinator muscle in the setting of facial synkinesis.
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of patients who underwent treatment for facial synkinesis with botulinum toxin over multiple treatment cycles during a 1-year period was carried out in a tertiary referral center.
Botulinum toxin treatment of facial musculature, including treatment cycles with and without buccinator injections.
Subjective outcomes were evaluated using the Synkinesis Assessment Questionnaire (SAQ) prior to injection of botulinum toxin and 2 weeks after treatment. Outcomes of SAQ preinjection and postinjection scores were compared in patients who had at least 1 treatment cycle with and without buccinator injections. Subanalysis was performed on SAQ questions specific to buccinator function (facial tightness and lip movement).
Of 84 patients who received botulinum toxin injections for facial synkinesis, 33 received injections into the buccinator muscle. Of the 33, 23 met inclusion criteria (19 [82.6%] women; mean [SD] age, 46 [10] years). These patients presented for 82 treatment visits, of which 44 (53.6%) involved buccinator injections and 38 (46.4%) were without buccinator injections. The most common etiology of facial paralysis included vestibular schwannoma (10 [43.5%] participants) and Bell Palsy (9 [39.1%] participants). All patients had improved posttreatment SAQ scores compared with prebotulinum scores regardless of buccinator treatment. Compared with treatment cycles in which the buccinator was not addressed, buccinator injections resulted in lower total postinjection SAQ scores (45.9; 95% CI, 38.8-46.8; vs 42.8; 95% CI, 41.3-50.4; P = .43) and greater differences in prebotox and postbotox injection outcomes (18; 95% CI, 16.2-21.8; vs 19; 95% CI, 14.2-21.8; P = .73). Subanalysis of buccinator-specific scores revealed significantly improved postbotox injection scores with the addition of buccinator injections (5.7; 95% CI, 5.0-6.4; vs 4.1; 95% CI, 3.7-4.6; P = .004) and this corresponded to greater differences between prebotulinum and postbotulinum injection scores (3.3; 95% CI, 2.7-3.9; vs 2.0; 95% CI, 1.4-2.6; P = .02). The duration of botulinum toxin effect was similar both with and without buccinator treatment (66.8; 95% CI, 61.7-69.6; vs 65.7; 95% CI, 62.5-71.1; P = .72).
The buccinator is a symptomatic muscle in the facial synkinesis population. Treatment with botulinum toxin is safe, effective and significantly improves patient symptoms.
尽管颊肌是中面部的重要肌肉，但在使用肉毒毒素治疗面肌联带运动时，它一直被忽视。
评估在面肌联带运动的情况下，使用肉毒毒素治疗颊肌的患者的治疗结果。
设计、地点和参与者：前瞻性队列研究，在一年的时间内，在一个三级转诊中心对接受肉毒毒素治疗面肌联带运动的患者进行了多次治疗周期的治疗。
肉毒毒素对面部肌肉的治疗，包括有无颊肌注射的治疗周期。
在注射肉毒毒素之前和治疗后两周使用面肌联带运动评估问卷（SAQ）评估主观结果。在至少有 1 个治疗周期并进行了颊肌注射和未进行颊肌注射的患者中比较 SAQ 注射前和注射后的评分。对特定于颊肌功能（面部紧绷和嘴唇运动）的 SAQ 问题进行了亚分析。
在 84 名接受肉毒毒素治疗面肌联带运动的患者中，33 名患者接受了颊肌注射。其中 23 名符合纳入标准（19 名[82.6%]女性；平均[SD]年龄，46[10]岁）。这些患者共接受了 82 次治疗就诊，其中 44 次（53.6%）涉及颊肌注射，38 次（46.4%）没有颊肌注射。面神经炎最常见的病因包括前庭神经鞘瘤（10 名[43.5%]参与者）和贝尔氏麻痹（9 名[39.1%]参与者）。所有患者的治疗后 SAQ 评分均较肉毒毒素治疗前有所提高。与未处理颊肌的治疗周期相比，颊肌注射导致治疗后 SAQ 总评分降低（45.9；95%CI，38.8-46.8；与 42.8；95%CI，41.3-50.4；P=0.43），且肉毒毒素治疗前后的差异更大（18；95%CI，16.2-21.8；与 19；95%CI，14.2-21.8；P=0.73）。对颊肌特异性评分的亚分析显示，在添加颊肌注射后，肉毒毒素治疗后的评分显著提高（5.7；95%CI，5.0-6.4；与 4.1；95%CI，3.7-4.6；P=0.004），且这与肉毒毒素治疗前后的评分差异更大（3.3；95%CI，2.7-3.9；与 2.0；95%CI，1.4-2.6；P=0.02）。无论是否进行颊肌治疗，肉毒毒素的效果持续时间相似（66.8；95%CI，61.7-69.6；与 65.7；95%CI，62.5-71.1；P=0.72）。
颊肌是面肌联带运动人群中的一个症状性肌肉。使用肉毒毒素治疗是安全、有效且能显著改善患者症状的。
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