Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany.
Department of Prosthetic Dentistry, School of Dental and Oral Medicine, University Hospital, University of Cologne, Cologne, Germany.
Clin Otolaryngol. 2021 Jul;46(4):758-766. doi: 10.1111/coa.13729. Epub 2021 Feb 15.
Treatment with botulinum toxin A (BoNT) is the therapy of choice for many patients with facial synkinesis. Repeated injections relieve hypertonicity and hyperkinesis of reinnervated mimic muscles. Aim of the study was to prove if the injection regime and dosage of BoNT change during long-time therapy.
Retrospective analysis of patients´ data, who were treated for synkinesis with BoNT from 1998 to 2018.
Tertiary referral facial nerve centre.
Injection pattern of BoNT was based on clinical symptoms, observations of the specialist and on previous treatment pattern. Onabotulinumtoxin (OnaBoNT), Incobotulinumtoxin (IncoBoNT) and Abobotulinumtoxin (AboBoNT) were available for treatment. Patients consulted our department for following treatment as soon as the symptoms re-occurred.
Change in dosage and injection pattern, the time intervals between treatments over the entire therapy period.
Seventy-three patients were repeatedly injected. The median number of treatments was 18, the median treatment interval was 3.0 months. During the initial treatment, orbicularis oculi and the mentalis muscles were the most frequently injected muscles (94%). During repeated treatment, the number of injected muscles increased significantly (P < .0001), whereas the dose per muscle remained stable. The initial dose was 24 U (95%-CI 22-27 U) for OnaBoNT and IncoBoNT; 69 U for AboBoNT(95%-CI 44-94 U). We observed a significant increase in dosage for OnaBoNT and IncoBoNT (P < .0001) during the long-term therapy. The time intervals between treatments were stable for all three BoNT preparations (P > .05).
We observed significant change in treatment dose and injection pattern of BoNT in patients with facial synkinesis. These results provide an orientation in dose finding and injection regimen of BoNT in the long-term course of therapy.
肉毒毒素 A（BoNT）治疗是许多面肌联带运动患者的首选治疗方法。反复注射可缓解再支配的模拟肌肉的张力亢进和运动亢进。本研究旨在证明在长期治疗过程中，BoNT 的注射方案和剂量是否发生变化。
对 1998 年至 2018 年间接受 BoNT 治疗面肌联带运动的患者数据进行回顾性分析。
三级面部神经中心。
BoNT 的注射模式基于临床症状、专家观察和以往的治疗模式。可使用注射用肉毒毒素（Onabotulinumtoxin，OnaBoNT）、注射用冻干粉型肉毒毒素（Incobotulinumtoxin，IncoBoNT）和注射用A型肉毒毒素（Abobotulinumtoxin，AboBoNT）进行治疗。一旦症状再次出现，患者就会到我们科室进行后续治疗。
整个治疗期间剂量和注射模式的变化，治疗间隔时间。
73 例患者反复接受注射。中位数治疗次数为 18 次，中位数治疗间隔为 3.0 个月。在初始治疗中，眼轮匝肌和颏肌是最常注射的肌肉（94%）。在重复治疗中，注射的肌肉数量显著增加（P <.0001），而每块肌肉的剂量保持稳定。OnaBoNT 和 IncoBoNT 的初始剂量为 24 U（95%CI 22-27 U）；AboBoNT 的剂量为 69 U（95%CI 44-94 U）。我们观察到 OnaBoNT 和 IncoBoNT 的剂量在长期治疗中显著增加（P <.0001）。三种 BoNT 制剂的治疗间隔时间均保持稳定（P >.05）。
我们观察到面肌联带运动患者 BoNT 的治疗剂量和注射模式发生了显著变化。这些结果为 BoNT 在长期治疗过程中的剂量发现和注射方案提供了方向。
