Wu Lei, Fu Yangshan, Zheng Fenshuang, Chen Jialong, Li Xingcheng
School of Medicine, Dali University, Dali, 671003, China.
Department of Emergency Medicine, The Affiliated Hospital of Yunnan University, Kunming, 650021, China.
Dysphagia. 2025 May 13. doi: 10.1007/s00455-025-10839-x.
Botulinum toxin (BoNT), a neurotoxic protein produced by Clostridium botulinum, is widely used for cosmetic and therapeutic purposes, including managing muscle hyperactivity, movement disorders, and chronic migraines by blocking acetylcholine release at neuromuscular junctions. While generally safe, it can cause localized adverse effects (erythema, ptosis, pain) and rare systemic complications (dysphagia, dysarthria, respiratory distress), particularly with improper dosing. From August 2024, This case report presents three female patients, aged 25, 50, and 49, in the Affiliated Hospital of Yunnan University, who experienced severe complications following the injection of botulinum toxin. The first patient, developed dysarthria and dysphagia 18 days post-injection, with a history of administration in northern Myanmar. The second patient, reported similar symptoms 3 days after a lesser dosage was injected into her masseter muscles. The third patient, exhibited fatigue and difficulty in eye opening and swallowing 7 days after receiving botulinum toxin. The symptoms of all patients were significantly improved after receiving symptomatic treatment in our hospital. The three cases presented are significant as they highlight the potential complications arising from botulinum toxin injections, particularly when used for cosmetic purposes. Botulinum toxin, though effective for cosmetic and therapeutic applications, carries risks of localized (muscle weakness, ptosis, bone loss) and systemic complications (generalized weakness, botulism), particularly near critical anatomical structures. Dysphagia and dysarthria, observed in cases post-injection, likely arise from toxin diffusion causing unintended muscle impairment. Treatment outcomes vary, with supportive care or invasive interventions often yielding limited improvement, highlighting management challenges. Clinicians must prioritize patient education, informed consent, and vigilant post-treatment monitoring for neurological symptoms. Future guidelines should standardize safe administration practices-optimizing dosage, injection sites, and follow-up-while enhanced practitioner training and multidisciplinary approaches are critical to mitigating risks and improving outcomes. This underscores the imperative for heightened clinical awareness and robust safety protocols to safeguard patient welfare.
肉毒杆菌毒素（BoNT）是由肉毒梭菌产生的一种神经毒性蛋白，被广泛用于美容和治疗目的，包括通过阻断神经肌肉接头处乙酰胆碱的释放来控制肌肉活动亢进、运动障碍和慢性偏头痛。虽然通常是安全的，但它可能会引起局部不良反应（红斑、上睑下垂、疼痛）和罕见的全身并发症（吞咽困难、构音障碍、呼吸窘迫），尤其是在剂量不当的情况下。自2024年8月起，本病例报告介绍了云南大学附属医院的三名女性患者，年龄分别为25岁、50岁和49岁，她们在注射肉毒杆菌毒素后出现了严重并发症。第一名患者在注射后18天出现构音障碍和吞咽困难，有在缅甸北部注射的病史。第二名患者在咬肌注射较小剂量后3天报告了类似症状。第三名患者在接受肉毒杆菌毒素7天后出现疲劳、睁眼和吞咽困难。所有患者在我院接受对症治疗后症状均有明显改善。所呈现的这三例病例具有重要意义，因为它们突出了肉毒杆菌毒素注射引起的潜在并发症，特别是在用于美容目的时。肉毒杆菌毒素虽然在美容和治疗应用中有效，但存在局部（肌肉无力、上睑下垂、骨质流失）和全身并发症（全身无力、肉毒中毒）的风险，尤其是在靠近关键解剖结构的部位。注射后病例中观察到的吞咽困难和构音障碍可能是由于毒素扩散导致意外的肌肉损伤。治疗结果各不相同，支持性护理或侵入性干预通常只能带来有限的改善，凸显了管理方面的挑战。临床医生必须优先进行患者教育、知情同意，并对神经症状进行密切的治疗后监测。未来的指南应规范安全给药做法——优化剂量、注射部位和随访——同时加强从业者培训和多学科方法对于降低风险和改善结果至关重要。这强调了提高临床意识和完善安全协议以保障患者福利的紧迫性。
