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Background and Objective: Myofascial pain syndrome (MPS) is a chronic musculoskeletal disorder characterized by the presence of trigger points. Among the treatment options, botulinum toxin injections have been investigated. The aim of this paper was to provide a synthesis of the evidence on intramuscular botulinum toxin injections for upper back MPS. Databases and Data Treatment: A systematic review of the literature was performed on the PubMed, Scopus and Cochrane Library, using the following formula: ("botulinum") AND ("musculoskeletal") AND ("upper back pain") OR ("myofascial pain"). Results: Ten studies involving 651 patients were included. Patients in the control groups received placebo (saline solution) injections, anaesthetic injections + dry needling or anaesthetic injections. The analysis of the trials revealed modest methodological quality: one "Good quality" study, one "Fair" and the other "Poor". No major complications or serious adverse events were reported. Results provided conflicting evidence and did not demonstrate the superiority of botulinum toxin over comparators. Most of the included trials were characterized by a small sample size, weak power analysis, different clinical scores used and non-comparable follow-up periods. Even if there is no conclusive evidence, the favourable safety profile and the positive results of some secondary endpoints suggest a potentially beneficial action in pain control and quality of life. Conclusion: The currently available studies show conflicting results. Their overall low methodological quality does not allow for solid evidence of superiority over other comparison treatments. Further insights are needed to properly profile patients who could benefit more from this peculiar injective approach. Significance: The randomized controlled trials included in this review compared using botulinum toxin to treat upper back MPS with placebo or active treatments (e.g., dry needling or anaesthetics) showing mixed results overall. Despite the lack of clear evidence of superiority, our study suggests that the use of botulinum toxin should not be discouraged. Its safety profile and encouraging results in pain control, motor recovery and disability reduction make it an interesting treatment, particularly in the subset of patients with moderate to severe chronic pain and active trigger points. To support the safety and efficacy of botulinum toxin, further high-quality studies are needed. [ABSTRACT FROM AUTHOR]

La paralysie faciale peut être source de séquelles esthétiques et fonctionnelles à types de spasmes et de syncinésies. L'injection de toxine botulique constitue un des traitements clefs de ces séquelles. Son utilisation est largement rapportée dans la littérature pour de nombreux muscles de la face mais peu pour le muscle buccinateur. Pourtant, son hyperactivité peut être invalidante, générant des troubles de la mastication et du sourire notamment. Le but de cette étude prospective est de rapporter les effets des injections de toxine botulique grâce à un questionnaire d'évaluation spécifique au muscle buccinateur. L'étude a été menée sur 13 patients. Les paralysies faciales étaient d'origines diverses. Le questionnaire comportait 10 questions évaluant chacune une mimique faciale impliquant le muscle buccinateur. L'échelle de notation allait de −10 (détérioration majeure) à 10 (amélioration majeure) pour chaque question. L'évaluation était effectuée à 1 et 4 mois de l'injection. Nous avons retrouvé une amélioration pour l'ensemble des mimiques et gestes évalués (0 à 7,38 à 1 mois et 0,15 à 6,62 à 4 mois). Cette amélioration est plus importante à 1 mois qu'à 4 mois. Peu d'effets secondaires ont été rapportés. Les injections de toxine botulique constituent une solution thérapeutique efficace, sûre pour le traitement des séquelles de paralysie faciale du muscle buccinateur au travers d'un questionnaire spécifique nouveau. Par la suite, il serait intéressant de réaliser une évaluation sur une population plus importante et comparative avec d'autres scores reconnus dans la paralysie faciale. Facial paralysis can cause aesthetic and functional sequelae such as spasms and synkinesis. Botulinum toxin injection is one of the key treatments for these sequelae. Its use is widely reported in the literature for many muscles of the face but little for the buccinator muscle. However, its hyperactivity can be disabling, generating chewing and smile disorders in particular. The aim of this prospective study is to report the effects of botulinum toxin using a questionnaire specifically for the buccinator muscle. The study was conducted on 13 patients. The facial paralysis was of various origins. The questionnaire consisted of 10 questions each assessing a facial mimic involving the buccinator muscle. The rating scale ranged from -10 (major deterioration) to 10 (major improvement) for each question. The evaluation was done at 1 and 4 months after the injection. We found an improvement for all the mimics and gestures evaluated (0 to 7.38 at 1 month and 0.15 to 6.62 at 4 months). This improvement was greater at 1 month than at 4 months. Few side effects were reported. Botulinum toxin injections are an effective, safe therapeutic solution for the treatment of the facial paralysis sequelae of the buccinator muscle through a new specific questionnaire. Subsequently, it would be interesting to carry out an evaluation on a larger population and to compare it with other recognized scores in facial paralysis. [ABSTRACT FROM AUTHOR]

Purpose: To compare the quality of life (QoL) in the same patients first treated with botulinum toxin A (BTA) injections for neurogenic detrusor overactivity (NDO) and then with bladder augmentation (BA)., Method: Retrospective study of patients who had BA after BTA treatment between January 2012 and December 2022. Qualiveen Short Form questionnaires and a 7-level Likert/PGI-I scale to answer the question "How would you describe your quality of life after surgery compared to when you felt your best with BTA injections?" were collated and analyzed., Results: Fifty-two BAs for neurogenic bladder (NDO or low compliance) were performed in patients with a median age of 43years [33; 52] previously treated with BTA. After a median follow-up of 33.5 [13.8; 54.3] months, the median Qualiveen-SF global score after BA was significantly higher than that obtained at best BTA efficacy (1.63 [1; 2.63] vs. 2.63 [1.88; 3], P=0.012), as were the scores for the fear, constraints/restrictions and limitations/inconvenience domains. The median PGI-I score was +3 [2; 3] (truly better QoL) and 85.4% of patients reported a QoL after BA superior to the best QoL under BTA., Conclusion: BA provides a greater range of QoL improvement than BTA injection for patients who have experienced both treatments. Long-lasting effects and absence of need to perform iterative retreatment were the main reasons., (Copyright © 2024. Published by Elsevier Masson SAS.)

Improving the survival rate of fat grafts is yet a difficult problem in the field of autologous fat transplantation. Prevailing methods such as making nanofat and SVF are time-consuming. Hence, the role of additives application in the improvement of fat graft survival during fat transplantation was considered and preliminarily evaluated in a rabbit animal model. A rabbit animal model was established where rabbit ears were injected with a mixture of 1.5 mL of adipose tissue and 1 mL of saline (group A), 1.5 mL of adipose tissue and 1 mL of botulinum toxin A (BoNTA) (group B), 1.5 mL of adipose tissue and 1 mL of prostaglandin E2 (group C), 1.5 mL of adipose tissue and 1 mL of PDRN (group D) respectively. Then, the extents of neovascularization and inflammation were evaluated on the 7th, 14th, 28th, 42nd, 56th and 70th day after injection by ELISA assays and H&E and immunofluorescence staining. The results showed that pre-treatment with BoNTA, prostaglandin E2 and PDRN improved graft volume and weight. The H&E and immunofluorescence staining revealed that BoNTA, prostaglandin E2 and PDRN improved the graft angiogenesis. Simultaneously, TNF-α expression level detected by ELISA was the lowest in the PDRN group. Henceforth, the present preliminary study suggests that pre-transplantation treatment with BoNTA, prostaglandin E2 and PDRN can improve the fat graft angiogenesis and graft integrity, whereby the effect of adding PDRN may be significant. [ABSTRACT FROM AUTHOR]

In this study we have based our research on botulinium toxin injection via targeted neuromuscular end plate zones, specifically in muscles with diffuse distribution of the latter. The muscular surface anatomical variety was also taken into consideration with thorough pre-injection examination of every subject. With consideration of the facial muscles anatomical variation and neuromuscular bundle distribution, we have applied the method of retrograde botulinium toxin injection on a series of 10 patients on the right side of the face with the left side as a control side, it was injected in a regular perpendicular manner in order to conclude the efficacy of targeted motor end zone injection. Using an auto-injecting syringe, we have delivered 6 Allergan units per zone (frontalis, glabellar lines of corrugator supercilii and orbicularis oculi crow's feet). On control day 8 we have noticed a more prominent effect mainly on the level of the orbicularis oculi muscle and the corrugator supercilii muscle on 9 out of 10 patients. Nine patients out of 10 needed the delivery of an additional 6 Allergan units per zone on the control side's glabellar lines and crow's feet rhytids. Where 1 out of 10 patients needed the reinjection of the control side on the glabellar lines zone. The musculature of the face varies when it comes to neuromuscular plate distribution. Muscles with scattered distribution patterns show an optimal response to botulinum toxin injections when delivered in a retrograde manner. This has allowed us to achieve of optimal results while minimizing injection sites and hence pain, the use of lower dosage and hence treatment cost, as well as lowering the unwanted product dissemination to the neighboring mimic muscles. [ABSTRACT FROM AUTHOR]

Botulinum toxin type A (BTA) injections in masticatory muscles are used to treat numerous clinical conditions. This neurotoxin causes atrophy and transient paralysis of the concerned muscles. The aim of this review is to gather and define the effects of BTA injections in masticatory muscles on the underlying cartilage and bone structures. Electronic search of Medline and Google scholar databases covering the period between January 2007 and July 2019 was carried out. Eligible articles were selected according to the inclusion/exclusion criteria. Fourteen articles were included. BTA injections may cause short term reduction of cortical bone thickness and trabeculation. On the long term, cartilage volume reduction and bone volume loss were evident on the condyle and mandibular angle, at both injected and non-injected mandibular bone structures. Bone mineral density remained unaffected when only one masticatory muscle was injected but was reduced when several masticatory muscles were treated with BTA. Several cellular and molecular alterations were noticed in some articles. Because of evidence of irreversible negative effects of BTA on the underlying structures, possible muscle, bone and cartilage volume reduction should be communicated to the patients prior to any intervention. Further studies are needed to fully understand the cellular mechanisms and molecular responses behind this phenomenon. [ABSTRACT FROM AUTHOR]

Les séquelles de paralysie faciale ont un impact psycho-social intense qui impose une prise en charge optimale au long court. Les challenges chirurgicaux sont nombreux et les moyens thérapeutiques sont à choix multiple. Nous proposons une analyse de ces traitements par le prisme de leurs écueils et de leurs limites. Les complications des principales interventions chirurgicales sont décrites ainsi que le détail des reprises chirurgicales nécessaires pour y faire face ou pour corriger rapidement les malfaçons. Par ailleurs les limites de résultat sont détaillées avec des propositions de retouches pour les améliorer. Enfin nous développons les nécessaires traitements itératifs ou les nouvelles propositions thérapeutiques indispensables à l'accompagnement au long court de ces patients dont les séquelles de paralysie faciale évoluent avec le temps et le vieillissement. La chirurgie des paralysies faciales n'est pas univoque. Elle nécessite humilité, patience et ténacité pour accompagner le patient tout au long de sa vie. Facial paralysis sequelae have an intense psycho-social impact which imposes an optimal care in the long run. The surgical challenges are numerous, and the therapeutic weapons are multiple. We propose an analysis of these treatments by the prism of their pitfalls and their limits. The complications of the main surgical procedures are described as well as the details of the rework necessary to cope with them or to quickly correct the defects. Moreover, the result limits are detailed with suggestions to improve them. Finally, we develop the necessary iterative treatments or new therapeutic proposals that are essential for the long-term care of these patients whose sequelae of facial paralysis evolve with time and aging. The surgery of facial paralysis is not unequivocal. It requires humility, patience and tenacity to support the patient throughout his life. [ABSTRACT FROM AUTHOR]

Analyser l'efficacité de l'injection de toxine botulique A dans les douleurs cervico-faciales post-radiques. Étude rétrospective incluant tous les patients traités dans notre centre par injection de toxine botulique A entre 2006 et 2017 pour douleurs cervico-faciales post-radiques. La douleur était évaluée par les patients sur une échelle visuelle analogique (EVA) entre 0 et 10, avant et un mois après la première injection. Seize patients ont été inclus dans l'étude. L'intensité des douleurs était en moyenne de 8,5 avant et de 0,8 après la première injection. Cette diminution de l'intensité de la douleur après les injections était statistiquement significative (p < 0,01). L'efficacité était majeure (EVA ≤ 3 après l'injection de toxine botulique A) chez 15 patients et complète (EVA = 0 après TBA) chez 11 patients. La toxine botulique est un traitement efficace des douleurs cervico-faciales post-radiques. To report the results of Botulinum Toxin A (BTA) for radiation-induced head and neck pain. This single-center retrospective study included all the patients treated at our institution with botulinum toxin A injections for radiation-induced head and neck pain between 2006 and 2017. Pain was evaluated by each patient on a visual analogue scale (VAS) (between 0 and 10) before, and 1 month after the injection. Sixteen patients were included in this series. The mean value of the pain was 8.5 before and 8 after the first injection. The difference was statistically significant (p < 0.01). Major response occurred in 15 patients (VAS ≤ 3 after BTA) and complete response in 11 patients (VAS = 0 after BTA). Botulinum toxin is an effective treatment for radiation-induced head and neck pain. [ABSTRACT FROM AUTHOR]

Les injections de toxine botulique en médecine esthétique sont les produits les plus utilisés, devant l'acide hyaluronique, et la médecine esthétique est en augmentation constante, y compris dans la population masculine. L'objectif de cette mise au point était de montrer les spécificités décrites dans la littérature concernant les injections de toxine botulique chez l'homme. Une recherche systématique de la littérature a été réalisée grâce au moteur de recherche Pubmed. Les données ont ensuite été collectées afin de connaître les spécificités des injections de toxine botulique chez l'homme en fonction de la morphologie du visage masculin et des désirs de ces patients. Les études réalisées montrent qu'il est nécessaire d'injecter des doses plus importantes chez l'homme que chez la femme pour obtenir un résultat satisfaisant, en raison d'une masse musculaire plus importante. Cette mise au point donne le nombre de points à réaliser par zone d'injection, ainsi que le nombre de points à effectuer, en comparaison à la population féminine. Les injections de toxine botulique à visée esthétique chez l'homme diffèrent par rapport à la femme. La prise en compte de ces particularités est indispensable à la satisfaction des patients. Botulinum toxin injections in aesthetic medicine are the most widely used products, ahead of hyaluronic acid, and aesthetic medicine is constantly increasing, including in the male population. The objective of this development was to show the specificities described in the literature concerning botulinum toxin injections in men. A systematic literature search was carried out using the Pubmed search engine. Data were then collected to determine the specificities of botulinum toxin injections in men according to the morphology of the male face and the wishes of these patients. The studies conducted show that it is necessary to inject higher doses in men than in women to obtain a satisfactory result, due to a higher muscle mass. This adjustment gives the number of points to be performed per injection site, as well as the number of points to be performed, compared to the female population. Botulinum toxin injections for aesthetic purposes in men are different from those in women. Taking these particularities into account is essential to patient satisfaction. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francophone de Recherche en Ergotherapie is the property of Communaute Pour l Avancement de la Recherche Appliquee Francophone en Ergotherapie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Le but de cet article est de présenter les différentes techniques de rajeunissement du front ainsi que leurs indications. Le lissage cutané, les injections de fillers ou de toxine botulique, le lifting frontal par voie endoscopique, par voie transpalpébrale ou le lifting classique par incision bicoronale doivent être parfaitement connus des chirurgiens plasticiens dans le cadre du traitement global du vieillissement du visage. Seule la chirurgie permet d’obtenir des résultats pérennes et nous devons la proposer dès que les stigmates du vieillissement sont installés. Summary The goal of this article is to provide a systemic approach to forehead rejuvenation. Fillers, botulinic toxin injections, transpalpebral, endoscopic or bicoronal brow lift must be usual techniques for every plastic surgeon in overall facial rejuvenation. Achieving a long lasting and aesthetically pleasing forehead is possible only with surgical techniques when aging is obvious. [ABSTRACT FROM AUTHOR]

Aim: To determine the surgical indication and results of bladder augmentation (BA) during the last decade in a neurourology center in the era of intradetrusor botulinum toxin injection., Material: We conducted a retrospective study that included patients with BA between January 1, 2012 and December 31, 2022 in our centre. We collected pre-operative demographic, clinical, and urodynamic data, BA indication, and associated procedures. We analyzed early and late complications as well as continence and postoperative voiding mode in patients with first BA in a neurological pathology context., Results: We performed 77 BA over the study period. The main indication was neurogenic overactive bladder, which was secondarily resistant to botulinum toxin. The main associated procedure was continent cutaneous diversion (n=31, 57.4%). Among patients who had a first BA for neurogenic bladder, 34 patients had early complications (50%) including 12 patients with≥Clavien 3 complications (17.6%). After a median follow-up of 33 [14; 55] months, 23 patients had late complications (33.8%) and 59 patients had complete continence (86.8%)., Conclusion: In the era of botulinum toxin, the main indication of BA is the secondary failure of botulinum toxin for overactive neurogenic bladder. The BA provided continence in 86.8% of patients. It remains however an intervention with a significant rate of severe complications whose indication must be discussed by a multidisciplinary team., Level of Evidence: Weak., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Aim: To assess the efficacy of switching to Abobotulinumtoxin A (ATA) intradetrusor injections (IDI) after failure of Onabotulinumtoxin A (OTA) IDI for the treatment of neurogenic detrusor overactivity in patients with spinal cord injury (SCI)., Materials and Methods: A single-centre retrospective chart review study. All SCI patients who started OTA IDI after 2011 and had an ATA IDI switch were included. The primary outcome was the clinical and urodynamic efficacy of the switch to ATA IIDs at the last follow-up. Secondary outcomes were initial efficacy, duration of ATA treatment, and patient outcome including the occurrence of augmentation enterocystoplasty at last follow-up., Results: Sixty-two patients were included. Eighteen patients (28.9%) were initially responders to ATA IDI. Nine patients (14.5%) remained responders at last follow-up after a median of 17 months (AE 8.8-29). Thirty-two patients (51.6%) had had or were awaiting augmentation enterocystoplasty with a follow-up time of 18.5 months (IQR 8-27). Eleven patients (17.7%) were on ATA IDI with low efficacy. Seven patients (11.3%) were switched back to OTA and 3 patients (4.8%) changed their voiding pattern., Conclusion: Switching from OTA to ATA toxin for IDI in the treatment of detrusor overactivity after spinal cord injury have long-term efficacy for a limited number of patients but may delay the need for surgery., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

La toxine botulique (TB) a fait son apparition en urologie dans le champ de la neuro-urologie comme traitement de la dyssynergie vésico-sphinctérienne et de l'incontinence par hyperactivité détrusorienne neurogène. Son action est maintenant clairement démontrée et constitue désormais un traitement largement utilisé dans l'hyperactivité vésicale neurogène. La toxine botulique peut-elle constituer un traitement efficace de l'hyperplasie bénigne de prostate (HBP)? L'injection intraprostatique de TB a récemment été étudiée dans le traitement de l'HBP. Elle semble permettre une amélioration importante des symptômes urinaires sans effets secondaires significatifs et pourrait donc représenter une alternative mini-invasive intéressante aux traitements classiques de l'HBP. Les avantages de son utilisation sont la simplicité de sa mise en oeuvre, l'absence d'effets secondaires rapportés et sa durée d'action prolongée. Des études soigneusement menées, prospectives, contrôlées portant sur des effectifs plus grands sont désormais nécessaires pour confirmer ces premiers résultats. Nous proposons a à travers ce travail une exposition des connaissances actuelles des mécanismes d'action de la TB au niveau prostatique et les résultats des principales études cliniques dans l'HBP.

Résumé La paralysie faciale (PF) de l’enfant est congénitale ou acquise. Lorsqu’elle est présente à la naissance (congénitale), elle est d’origine traumatique dans la plupart des cas, ou plus rarement, développementale. La PF acquise doit faire rechercher une étiologie pour guider le pronostic et le traitement, même si aucune cause n’est identifiée dans la plupart des cas. Au stade aigu, le traitement de la PF idiopathique repose sur la corticothérapie orale le plus rapidement possible et la protection cornéenne. Au stade des séquelles, comme chez l’adulte, le traitement est global en prenant en compte l’équilibre dynamique des deux côtés du visage. La réanimation dynamique doit prévaloir principalement à l’étage inférieur. Notre choix technique se porte sur la myoplastie d’allongement du temporal (MAT) qui offre la possibilité d’une réanimation du sourire fiable et reproductible. Toute réanimation dynamique par MAT ou lambeau musculaire libre doit être suivie d’une rééducation spécifique prolongée qui accompagne le patient d’un sourire mandibulaire à un sourire spontané grâce à la plasticité cérébrale. Par ailleurs, la toxine botulique, très bien tolérée et peu invasive, est une aide précieuse chez l’enfant capable d’en supporter les injections. Summary Facial palsy (FP) in children is congenital or acquired. When present at birth (congenital), etiologies are mostly traumatic and rarely developmental. Acquired FP needs investigation. Research on the etiology helps to determine prognostic and treatment. At most times, no specific cause is found. Treatment of idiopathic FP consists of early oral corticosteroid therapy and ocular protection. Treating the sequelae is essential and the physician has to consider the dynamic balance of both sides of the face. Dynamic rehabilitation should mainly concern the inferior facial third. We recommend the lengthening temporalis myoplasty (LTM). This relevant technique ensures replicable and reliable results with a harmonious smile. Facial dynamic rehabilitation after surgical procedure (muscle tranfer or free muscle flap) must be directed toward control of voluntary movement, to move from a mandibular smile to a spontaneous and voluntary smile, thanks to brain plasticity. Furthermore, botulinum toxin is well tolerated and remains a great tool to treat a child who can support injections. [ABSTRACT FROM AUTHOR]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La toxine botulique appartient à l’arsenal thérapeutique de tout ophtalmologiste devant gérer la pathologie oculomotrice. Son injection effectuée parfois sous microscope est un geste rapide et peu invasif. Bien qu’effectuée hors AMM chez l’enfant lors des strabismes précoces, il faut savoir la proposer aux parents. Devant toute paralysie oculomotrice susceptible de régresser spontanément, il est licite de proposer au patient une injection de toxine botulique afin d’attendre avec beaucoup plus de confort l’heure d’une éventuelle chirurgie.

Summary Study objectives Botulinum toxin is a key therapeutic tool in the comprehensive treatment of peripheral facial paralysis. It fights spasms, synkinesis and overactivity of the different skin muscles responsible of facial expressions. Even though injection techniques as well as target muscles have been well identified, doses used remain quite imprecise and often not detailed muscle by muscle, further more dosage progression has not been monitored over time. Our retrospective study is the first one to refine the repartition of botulinum toxin doses on each of the relevant skin muscles and assess dosage kinetics. Patients and methods Thirty patients were included since 2008 with a mean follow-up of 2.3 years. Each patient had at least 3 injections, with a delay of 4 to 6 months between each injection. Results Mean doses are indicated for each muscle injected on the paralyzed and healthy sides. Dose kinetics suggests an initial dosage increase after the first injection followed by a decrease over time. No treatment resistance was observed. Conclusion Our study represents a didactic help in using botulinum toxin for sequelae of peripheral facial paralysis by providing more details on the effective mean doses for each muscle and their progression over time. [ABSTRACT FROM AUTHOR]

Résumé L’injection de toxine botulique au niveau de la région axillaire est une procédure visant à traiter de manière temporaire l’hyperhidrose axillaire. Cette technique décrite en 1996 par Bushara et al. a fait la preuve de son efficacité et de sa tolérance satisfaisante. L’objet de cet article est de faire le point sur le traitement de l’hyperhidrose axillaire par injection de toxine botulique de type A, et de discuter la place des autres modalités de traitement de cette affection socialement invalidante. Summary Injection of type A botulinum toxin in the armpits is a temporary treatment for axillary hyperhidrosis. This technique described in 1996 by Bushara et al., is known to be efficient and safe. The purpose of this article was to review the data concerning the treatment of axillary hyperhidrosis with botulinum toxin type A, and discuss the other treatment modalities for this socially disabling entity. [ABSTRACT FROM AUTHOR]

Bruxism is characterized by centric and eccentric teeth grinding with intense static muscle forces respectively in the vertical and horizontal plane. This parafunction is usually treated with drugs for muscle relaxation and occlusal appliance. In some severe cases of bruxism these therapies are ineffective. The emergence of botulinum toxin and its use in various pathologies even in bruxism have transformed the quality of life of patients. In this work we emphasize the effect of the botulinum toxin while discussing the etiology of bruxism and the mechanism of action of botulinum toxin in the treatment of severe bruxism. [ABSTRACT FROM AUTHOR]

Résumé Le traitement médical des séquelles de la paralysie faciale est une part essentielle de la prise en charge globale de cette pathologie. L’utilisation de la toxine botulique de manière courante a révolutionné les résultats obtenus en améliorant grandement la symétrie faciale. La toxine peut être utilisée soit du côté sain du visage en traitant l’hyperactivité compensatrice du côté non paralysé de la face, soit du côté paralysé (dans les formes spastiques) afin de traiter les co-contractions et les spasmes du côté du visage atteint. Ce traitement devra bien entendu être complété par le reste de la thérapeutique à savoir la rééducation et le traitement chirurgical. Summary Medical treatment of facial paralysis sequel is an essential part of the overall management of this pathology. The use of botulinum toxin has revolutionized results in greatly improving facial symmetry. The toxin can be used either the healthy side of the face by treating the compensatory hyperactivity of non-paralyzed side of the face or the paralyzed side (in the spastic forms) to treat synkinesis and spasms of the face on the pathologic side. This treatment course will be complemented by the rest of the therapeutic, i.e. rehabilitation and surgical treatment. [ABSTRACT FROM AUTHOR]

Résumé L’utilisation de fillers, soit comme camouflage après une rhinoplastie chirurgicale, soit comme technique de rhinoplastie médicale, est devenu un apport intéressant permettant d’éviter ou de retarder une échéance chirurgicale toujours redoutée par le patient. Le geste peut paraître simple mais les auteurs insistent sur la nécessité d’une technique rigoureuse, car si les complications sont rares, elles n’en demeurent pas moins graves voire dramatiques. Au travers de leur expérience de plus de 7 ans, les auteurs n’ont retenu que deux substances résorbables type acide hyaluronique ou hydroxyapatite de calcium, produits reconnus par l’ANSM. Les microcanules (27 G) sont préférées aux aiguilles, ainsi que les techniques d’injection par de multiples tunnels avec des petits bolus fragmentés. Il faut éviter une injection isolée en grande quantité, source de blanchiment et de risques plus importants pour la peau. L’hydroxyapatite est préféré pour le dorsum et l’acide hyaluronique pour la pointe. Les auteurs rapportent également les principales complications et leurs traitements. La meilleure thérapeutique reste néanmoins dans leur prévention en grande partie due à l’application d’une technique rigoureuse. Summary The use of fillers for camouflage after surgical rhinoplasty or during medical rhinoplasty process represent an attractive technique which allows to avoid or to delay surgical time often dreaded by the patients. This technique apparently quite simple, must be applied carefully in order to avoid possible complications that can sometimes be very serious. Through their seven years of experience, the authors have selected absorbable type of products: hyaluronic acid or calcium hydroxylapatite, both approved by ANSM. Preference is given to microcannulas (27G) over needles and injection techniques through multiple tunnels fitted with small fragmented boluses. Due to possible Tyndall effect and skin necrosis risk, a one-shot injection with a lot of product should be avoided. Calcium hydroxyapaptite is preferred for the dorsum area while hyaluronic acid is recommended for the tip. The authors also relate the major encountered complications and describe the appropriated treatments. Nevertheless the strict application of the described technique represents the best way to prevent adverse complications. [ABSTRACT FROM AUTHOR]

Objective In this study, we consider two localization techniques used in injections of botulinium toxin in children: electrical stimulation and ultrasound. The hypothesis of this work was that injections performed without stimulation would be less painful. Patients and methods Monocentric prospective study, with 107 sessions of lower limb injections. Two groups of children were compared: localization by ultrasound only (60 children), detection by stimulation only or by stimulation combined with ultrasound (47 children). Pain assessment was performed by the child or an accompanying party using the Visual Analog Scale (VAS) and by a health care team using the Face, Legs, Activity, Cry, Consolability (FLACC). Results A significant difference between the two groups was found in both self-report and by means of the behavioral observational pain scale. Indeed, VAS average and FLACC average were significantly higher with detection by stimulation than with ultrasound alone: 4.5 cm ± 2.54 versus 2.7 cm ± 2.27; P < 0.001 for VAS scale and 3.7 ± 2.1 versus 2.7 ± 2.3; P < 0.05 for FLACC scale. Conclusion When compared to ultrasound detection, localization by electrostimulation appears to increase the overall pain caused during injections of botulinum toxin in children. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Botulinum toxin (BT) is used in a variety of therapeutic applications, including the treatment of strabismus. Two injection techniques coexist - transconjunctival injection and open sky injection. The goal of this study was to evaluate the results of BT injections in esotropia in children under 10 years of age and to compare the two techniques., Patients and Method: This is a retrospective, monocentric study, including children who received BT injections to treat their strabismus by the aforementioned techniques between 2014 and 2017. The results of these injections were recorded, and subgroup analyses (injection technique, age, degree of deviation, type of strabismus) were performed. The primary endpoint was the optimal success rate defined as residual strabismus less than or equal to 10 Δ., Results: The study included 68 children with a mean age of 28.9 months and a mean deviation angle of 34.7 Δ. Patients received 1.2 BT injections. The success rate was 38% at 6 months, 35% at 12 months, and 35% at 24 months. There was 33% transient ptosis and 5% consecutive exotropia. There was no evidence of significant difference in success rate between the transconjunctival and open sky injection methods, baseline angles, age of injection, or type of strabismus., Conclusion: BT injection is effective and safe in pediatric esotropia, regardless of the injection method., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Summary: Introduction: The purpose on this work was to analyze the interest to use a walkway GAITRite® to assess the progress of stroke patients who received treatment with botulinum toxin in the lower limb. Methods: Ten healthy subjects and 21 patients were registered on the system during eight walking test at free velocity. They were tested one week before and then six weeks after the injection. The spatiotemporal parameters were measured, gait variability and asymmetry of the locomotor pattern calculated. Conclusion: This protocol allow us to distinguish patients from control subjects on all parameters measured. Toxin injections affect walking velocity, time support, asymmetry and variability between the two members. No differences were observed on the step length and swing time. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Hypertrophy of the masticatory muscles most commonly affects the masseter. Less common cases of isolated or associated temporalis hypertrophy are also reported. Parafunctional habits, and more precisely bruxism, can favor the onset of the hypertrophy. This condition is generally idiopathic and can require both medical and/or surgical management. Observation: A 29-year-old patient was referred to our department for an asymmetric swelling of the masticatory muscles. Physical examination revealed a bilateral hypertrophy of the masticatory muscles, predominantly affecting the right temporalis and the left masseter. Major bruxism was assessed by premature dental wearing. The additional examinations confirmed the isolated muscle hypertrophy. Benign asymmetric hypertrophy of the masticatory muscles promoted by bruxism was diagnosed. Treatment with injections of type A botulinum toxin was conducted in association with a splint and relaxation. Its effectiveness has been observed at six months. Discussion: Few cases of unilateral or bilateral temporalis hypertrophy have been reported, added to the more common isolated masseter muscles hypertrophy. The diagnosis requires to rule out secondary hypertrophies and tumors using Magnetic Resonance Imaging. The condition is thought to be favoured by parafunctional habits such as bruxism. The conservative treatment consists in reducing the volume of the masticatory muscles using intramuscular injections of type A botulinum toxin. Other potential conservative treatments are wearing splints and muscle relaxant drugs. Surgical procedures aiming to reduce the muscle volume and/or the bone volume (mandibular gonioplasty) can be proposed. [ABSTRACT FROM AUTHOR]

Summary: Introduction: After facial paralysis recovery, it is common to note a co-contraction between depressor anguli oris (DAO) muscle and zygomatic muscles. This DAO co-contraction will “obstruct” the patient''s smile. The purpose of this technical note is to show how to find the DAO sign and how to free up the smile. Technical: This co-contraction between the zygomatic muscles and DAO research is placing a finger on marionette line, asking the patient to smile: we perceive a rope under the skin corresponding to the abnormal contraction and powerful DAO. A diagnostic test with lidocaine injection into the DAO can be performed to confirm the diagnosis. The treatment of pathological DAO''s contraction can be by injection of botulinum toxin in the DAO, or by surgical myectomy. In all cases, a speech therapy complete the treatment. Conclusion: The DAO sign is a semiological entity easy to find. His treatment releases smile without negative effect on the facial expression as the DAO is especially useful in the expression of disgust. [Copyright &y& Elsevier]

L’incontinence urinaire touche plus de trois millions de Français, toutes catégories d’âge confondues. Ce trouble, le plus souvent mal accepté et vécu comme tabou par les personnes qui en souffrent, a vu sa prise en charge progresser de façon considérable ces dernières années. Celle-ci est multidisciplinaire et fait appel à la fois à la rééducation fonctionnelle, aux traitements médicamenteux et aux techniques chirurgicales. [Copyright &y& Elsevier]

Abstract: Introduction: Pain is the main problem in patients suffering from cerebral palsy, particularly in adults. The upper limbs are affected in 25% of cases. Here, we report the case of a patient with Kienböck''s disease. Method: Clinical case and literature review. A 28-year-old man suffering from dystonic quadriplegia consulted for progressively worsening pain in the right wrist. Kienböck''s disease was diagnosed and conservative treatment with botulinum toxin in the flexor carpi radialis recommended. A good result was obtained with a decrease in pain. This result was still present two years later. Discussion: Although few references are made to it in literature, Kienböck''s disease in cerebral palsy is probably underestimated. Maintenance of the wrist in a permanent flexed position and muscular hypertonia may be risk factors. Knowledge of this particular clinical picture will enable it to be detected promptly and thus enable conservative treatment to be organised with a maximum chance of therapeutic success, preventing the need for surgery. [Copyright &y& Elsevier]

Abstract: Aims: To evaluate the effectiveness of an analgesic protocol with nitrous oxide and anaesthetic cream (lidocaine and prilocaine, EMLA) for children undergoing botulinum toxin injections. Patients and methods: Prospective study including 51 injection sessions, 34 children with a mean age of 5.94 (range 2–15) and 209 injected muscles. Pain was evaluated with the Children''s Hospital of Eastern Ontario Pain Scale (CHEOPS), the Visual Analogue Scale (VAS) and the Face Pain Scale (FPS) for the children and with a VAS for the parents. Results: CHEOPS score for the 51 sessions was 8.50 (S.D. 3.56). Forty-nine percent of scores were above the therapeutic threshold of 9; 25% of the children evaluated the pain above the therapeutic threshold of 3; 44.74% of the parents’ estimations exceeded 3. No correlation was found between age, weight, number of injected muscle and CHEOPS score. Conclusion: The association of MEOPA and anaesthetic cream is only effective for 50% of children. This is much lower than treatments for other types of acute induced pain in children. Botulinum toxin injections and cerebral palsy children present certain specificities which require improvements in this analgesic protocol. [Copyright &y& Elsevier]

Abstract: Purpose: To study the value and efficacy of botulinum toxin for treatment of cases of non-neurogenic detrusor overactivity (NNDO) that are refractory to anticholinergic drugs. Materials and methods: A systematic review of the literature, based on a keyword search of the Medline database. Selection of articles in French and English (meta-analyses, reviews, case studies and randomized, controlled clinical trials) on intradetrusor botulinum toxin injection in the management of refractory NNDO. Results: Nineteen publications (including three randomized, controlled trials) were selected. Intradetrusor injection of botulinum toxin in patients with refractory NNDO has produced promising results, with a significant improvement in physical symptoms, urodynamic parameters and quality of life. The rare side effects consist primarily of dose-dependent urine retention. Conclusion: On the basis of preliminary data, botulinum toxin appears to be a valuable therapeutic option and fills the gap between anticholinergics and surgery in the treatment of NNDO that is refractory to anticholinergic agents. Botulinum toxin has a promising future in urology but requires further scientific evaluation. [Copyright &y& Elsevier]

Summary: Better new understanding of midfacial ageing and new techniques such as botulinum toxin and hyaluronic acid injections have widely changed the approach of the treatment. After reviewing the different available products, the author preconizes for each an overview with indications, limits and possible complications. The author highlights the benefit of these techniques for lower lid and tear trough treatments. Besides, the author suggests associating these techniques for natural and long lasting results. [Copyright &y& Elsevier]

Résumé: Nous rapportons l’utilisation intra-articulaire de la toxine botulique A chez deux patients avec une monoarthrite douloureuse persistante localisée au niveau des articulations de la cheville et du pied. Les deux patients présentaient une douleur monoarticulaire malgré une bonne réponse de toutes des autres articulations à une association thérapeutique incluant un traitement par anti-TNF. Les injections intra-articulaires de corticostéroïdes ont été un échec et les patients ont refusé les options chirurgicales. Après une injection unique intra-articulaire, hors AMM, de toxine botulique A dans, respectivement, la cheville droite (100 unités) et la première articulation métatarsophalangienne gauche du pied (25 unités), la douleur et la fonction se sont significativement améliorées (≥ 40 %) chez les deux patients. Une réponse durable avec une amélioration de la douleur et de la fonction a été observée pendant 15–18 mois (suivi en continu). Le gonflement de l’articulation de la cheville a été résolu en 15 mois et celui de l’articulation metatarsophalangienne (MTP) en un mois. L’injection intra-articulaire de toxine botulique A (IA BoNT/A) pourrait être une option thérapeutique complémentaire pour des patients atteints de polyarthrite rhumatoïde avec une monoarthrite persistante. Une étude randomisée est en cours pour confirmer ces résultats. [Copyright &y& Elsevier]

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: The actual gold standard of Botulin A toxin (BoTx A) batches qualification is the mouse lethality assay. With this assay it is nevertheless impossible to set a therapeutic value unit. Aims: The goal of this research was to study the effects of BoTx A increasing concentrations on glutamatergic rat neurons. Experimental procedure: We studied the glutamate release with increasing concentrations of BoTx A. We also studied the BoTx A target cleavage with a western blot technique. Results: Our results proved that it is possible to establish a dose-response – like curve of BoTx A effects on glutamate release. Moreover the cleavage of the target protein was visible for the same toxin concentrations that inhibited the glutamate release. Conclusion: This technique could be the first step toward a new way of setting a better pharmaceutical profile for toxin batches. [Copyright &y& Elsevier]

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Injections of botulinum toxin into the detrusor is a major evolution for treatment of neurogenic bladder. They are now considered as a treatment of choice, safe and efficient, in refractory neurogenic overactivity in catheterized patient. To date, there are no consensual practical guidelines for the follow-up of patients having been treated by intradetrusor botulinum toxin, whatever the indication of the treatment, functional, that is, for improving continence and overactive bladder syndrome or organic, that is, for treatment of high-detrusor pressure and their deleterious impact of urinary tract. This lack of guidelines leads to heterogeneity of treatment management and limit the definition of optimal modalities of intradetrusor botulinum toxin treatment in neurogenic patients. The aim of your work, prepared jointly with the International Francophone Neuro-Urological expert study group (GENULF), aimed at putting forward well-informed specific recommendations for the follow-up of patients having been treated by intradetrusor botulinum toxin for functional or organic indication of neurogenic detrusor overactivity. [Copyright &y& Elsevier]

Abstract: We are reporting the use of a xylocain test before the injection of botulinal toxin within the "facial paralysis and botulinal toxin" multidisciplinary consultation of the Caen regional hospital. Our assessment is about 16 patients tested. This test is based on a digital film and a questionnaire. It is often proposed when toxin is first used. It influences the patient''s choice. It permits a better understanding of the toxin action by the patient, it reassures. It is reliable for the practitioner even though we do not have a mathematical correlation between the xylocain volume and the botulinal toxin volume. Simple and far, it is a help for the patient and the practitioner before a delicate injection of botulinal toxin. [Copyright &y& Elsevier]

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: This study corroborates that the resting tone is indeed increasing with age. And that like in the Face Recurve® concept, the deep fat is expelled superficially because of mimic muscle shortening. Botulinum toxin is therefore described for a new indication: resting tone decrease in order to slow down muscle shortening and consequently structural aging. Injections can be performed very early in the ageing process, when it is only visible in contraction, before the appearance at rest of wrinkle. Precision of the injection is related to the recent determination of motor end plate location in every mimic muscle. Finally, a new possibility for botulinum toxin injection is the blockage of muscular regeneration in order to stabilize the section of the age marker fascicles performed in the Face Recurve® concept. This new indication is also useful in reconstructive surgery for treatment of the marginal mandibular lip deformity in patients with chronic unilateral facial palsies. [Copyright &y& Elsevier]

Abstract: Objective: To investigate modification of postural control after treatment with botulinum toxine in leg muscles of stroke patients. Methods: We performed a retrospective study of stroke patients who benefitted from injection of botulinum toxine in leg muscles between June 2003 and October 2004. The assessment before and after the injection relied on clinical examination and on posturographic recording on 2 force plates with the patient standing, with eyes open performing or not a double task consisting of an arithmetic test and with eyes closed. We also compared patients to healthy subjects. Results: Eight patients were included in the study. Botulinum toxine injection in the leg muscles significantly decreased the triceps spasticity, with no change in clinical assessment of balance control (Fugl-Meyer scale). The posturographic data show a decrease in the area of centre of pressure displacement in the double-task situation after the injection. Conclusion: Thanks to the posturographic recording in the double-task situation, we showed a modification of postural control after treatment with botulinum toxine in leg muscles of stroke patients. [Copyright &y& Elsevier]

Abstract: Cell ageing is responsible for the increasingly creased appearance of our skin. The ageing of the structures of the face is attributed primarily to the effect of gravity on the tissues. The theory expounded below sets out to prove that the main and initial cause of this ageing is the repeated contractions of the mimic muscles. This concept attributes only a secondary role to gravity in the ageing process, which is initially brought about by muscular contractions. An MRI study recently made it possible to demonstrate the anterior convexity curve of the mimic muscles in the young subject. This curve is due to the existence at the back of these muscles of a deep fat pad. In the young subject, the extent of its convexity and its location give a specific, youthful character to the movements, in terms of direction and amplitude, of the facial muscles. With age, the muscle gradually straightens and shortens due to the repeated contractions that expel the underlying fat and increase the tonus at rest. The application of these new findings to the ageing of the face gives rise to new technical possibilities both in the field of medicine and aesthetic surgery. These new techniques have the same targets: segments of the mimic muscles (maintain over time a good muscular curve and a low tonus at rest) and the underlying fatty convexities. As far as medicine is concerned, the combination of botulinum toxin and filling has proved its worth. But two technical elements are new: the filling products must, at several points, be injected primarily behind the muscle to treat the depressions naturally and restore the initial curve of the overlying muscle. A very low number of units (a quarter to one unit) of botulinum toxin must be injected into certain muscles to diminish the tonus at rest of these muscles without diminishing their strength in maximum contraction. In surgery, new possibilities to treat premature ageing include procedures that combine segmentary muscular weakening, micro liposuctions and retromuscular reinjections. The advantage with regard to the medical procedures is greater stability over time and the greater precision of these muscular actions (one third of a muscle can be weakened for example) and the fat reinjections can be more stable. These procedures can be performed under local anesthesia. In cases of more advanced ageing, surgery offers new treatment possibilities that include, for the midface region, the concentric malar lift. It replaces, on the orbital rim, the sub-orbicularis oculi fat that has descended eccentrically as a result of the contractions of the orbicularis oculi muscle. The procedure, using the subperiosteal detachment plane, is therefore stable over time. At the same time, specific muscles are weakened. The aims of restoring fatty volumes and muscular tonuses are thus achieved. Similarly, in the neck, the platysma muscle is specifically weakened. Each area is studied in line with its specificities. For the first time, the skin tension of the facelift has no more to be maximum to treat the relief of the jawl line, of the palpebro malar groove and so on. The skin tension becomes moderate, just to remove the excess of skin. The relief is faded with the specific muscular and fatty action. The name of this new concept is Face Recurve®. [Copyright &y& Elsevier]

Copyright of Pelvi-Perineologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Overactive bladder is very frequent in central neurogenic patients; it is a major cause of refractory incontinence despite anticholinergic treatment. In non-neurogenic patients it results in very distressing symptoms that associate urgency with or without incontinence and frequency. Botulinum toxin A is a well known agent used previously in the treatment of striated muscle spasmodism, which blocks the release of acetylcholine from nerve endings and neuro-muscular transmission. Its recent use in urology revealed a dramatic improvement in clinical and urodynamic parameters of the overactive bladder, associated with a long lasting effect over 6 to 9 months and an excellent tolerance. In neurogenic patients, the efficacy of botulinum injection was demonstrated over a placebo control group. Toxin was injected at 20 to 30 different sites in the detrusor muscle, with cystoscopy guidance. Recent studies showed a sub-epithelial mechanism of action on neuropeptides, which could explain an inhibitory effect of both efferent and afferent arms of the micturition reflex. Further studies remain necessary regarding the respective doses of Dysport® and Botox® toxin, selection of patients, combination with anticholinergic treatment, effects of repeated injections. [Copyright &y& Elsevier]

Abstract: Spasticity is one of the most common motor and tonus disorders during the initial phase with traumatic brain injured patients. The evaluation of spasticity is mainly clinical but it is very important to prevent complications such as limitation of range of motion, pain, decubitus ulcers. The therapeutic options consist in classical indications such as baclofen, dantrolene, tizanidine, benzodiazepine, associated with physiotherapy. Other additive therapeutic options could be discussed: use of toxin botulinum in focal spasticity and intrathecal baclofen infusion in case of severe spasticity (often associeted with dysautonomic disorders.). [Copyright &y& Elsevier]