Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee.
Vanderbilt University School of Medicine, Nashville, Tennessee.
JAMA Facial Plast Surg. 2019 May 1;21(3):244-251. doi: 10.1001/jamafacial.2018.1962.
In the last decade, there has been a significant increase in the number of practitioners administering botulinum toxin for facial synkinesis. However, there are few resources available to guide treatment patterns, and little is known about how these patterns are associated with functional outcomes and quality of life.
To evaluate botulinum treatment patterns, including the dosing and frequency of muscle targeting, for treatment of facial synkinesis and to quantify patient outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study of 99 patients treated for facial synkinesis was conducted from January 2016 through December 2018 at the Vanderbilt Bill Wilkerson Center in Nashville, Tennessee, a tertiary referral center.
Onabotulinum toxin A treatment of facial synkinesis.
Patient-reported outcomes on the Synkinesis Assessment Questionnaire and botulinum treatment patterns, including the dosages and frequency of injection for each facial muscle, were compared at the initiation of treatment and at the end of recorded treatment.
In total, 99 patients (80 female patients [81%]) underwent botulinum injections for treatment of facial synkinesis. The median (interquartile range) age was 54.0 (43.5-61.5) years, and the median (interquartile range) follow-up was 27.1 (8.9-59.7) months. Most patients underwent injections after receiving a diagnosis of Bell palsy (41 patients, 41%) or after resection of vestibular schwannoma (36 patients [36%]). The patients received a total of 441 treatment injections, and 369 pretreatment and posttreatment Synkinesis Assessment Questionnaire scores were analyzed. The mean botulinum dose was 2 to 3 U for each facial muscle and 9 to 10 U for the platysma muscle. The dose increased over time for the majority of all muscles, with steady state achieved after a median of 3 treatments (interquartile range, 2-3). Linear regression analysis for cluster data of the mean total questionnaire score difference was -14.2 (95% CI, -17.0 to -11.5; P < .001). There was a significant association of postinjection questionnaire score with younger patients, female sex, total dose, and synkinesis severity. Oculo-oral synkinesis may respond more to treatment compared with oro-ocular synkinesis.
Patients with facial synkinesis responded significantly to botulinum treatment. Treatment began with 6 core facial muscles that were injected during most treatment sessions, and dosages increased after the first injection until steady state was achieved. Those with a greater degree of morbidity, younger patients, and females showed significant improvement, and the larger the dose administered, the greater the response. Oculo-oral synkinesis may be more responsive than oro-ocular synkinesis.
在过去的十年中，有越来越多的医生采用肉毒毒素治疗面部运动障碍。然而，目前可用的指导治疗模式的资源很少，并且对于这些模式如何与功能结果和生活质量相关知之甚少。
评估肉毒毒素治疗面部运动障碍的治疗模式，包括肌肉靶向的剂量和频率，并量化患者的治疗效果。
设计、地点和参与者：这是一项对 99 名在田纳西州纳什维尔范德比尔特比尔威尔克森中心接受面部运动障碍治疗的患者进行的前瞻性队列研究，该中心是一家三级转诊中心。研究从 2016 年 1 月持续到 2018 年 12 月。
肉毒毒素 A 治疗面部运动障碍。
在治疗开始时和记录治疗结束时，使用面部运动障碍问卷（Synkinesis Assessment Questionnaire）比较患者报告的治疗效果和肉毒毒素治疗模式，包括每个面部肌肉的剂量和注射频率。
共 99 名患者（80 名女性[81%]）接受了肉毒毒素注射以治疗面部运动障碍。患者的中位（四分位间距）年龄为 54.0（43.5-61.5）岁，中位（四分位间距）随访时间为 27.1（8.9-59.7）个月。大多数患者在诊断为贝尔麻痹（41 例，41%）或前庭神经鞘瘤切除后（36 例[36%]）接受注射治疗。患者共接受了 441 次治疗注射，对 369 次治疗前和治疗后 Synkinesis Assessment Questionnaire 评分进行了分析。平均每个面部肌肉的肉毒毒素剂量为 2-3U，颈阔肌的剂量为 9-10U。大多数肌肉的肉毒毒素剂量随着时间的推移而增加，中位治疗 3 次后达到稳定状态（中位数，2-3）。对于平均总问卷评分差异的聚类数据进行线性回归分析，差异为-14.2（95%置信区间，-17.0 至-11.5；P < 0.001）。注射后问卷评分与年轻患者、女性、总剂量和运动障碍严重程度显著相关。眼口运动障碍可能比口眼运动障碍对治疗的反应更敏感。
面部运动障碍患者对肉毒毒素治疗有显著反应。治疗开始时针对 6 个核心面部肌肉进行注射，大多数治疗期间都会进行注射，并且在第一次注射后增加剂量，直到达到稳定状态。那些病情更严重、年龄较小和女性患者的改善更为显著，且剂量越大，反应越好。眼口运动障碍可能比口眼运动障碍更敏感。
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