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Botulinum Toxin Injection in Long-Standing Facial Paralysis Patients: Improvement of Facial Symmetry Observed up to 6 Months

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Abstract

Background

Despite modern reanimation surgical techniques, facial paralysis presents with functional and aesthetic deficits. We evaluated facial symmetry after treating with botulinum toxin the healthy side of the face of 25 patients with long-standing facial paralysis who had previously been treated by surgical methods, with 6 months follow-up.

Methods

Evaluation consisted of a clinical score, the two subscales of the Facial Disability Index, and surface electromyography. The mean botulinum toxin dose was 38 ± 5 U (range = 15–69 U).

Results

The clinical score showed significant reduction of asymmetry of 48.4% at 1 month and 16.8% after 6 months. The initial result was a consequence of reduced motion on the treated side combined with better motion on the paralyzed side. At 6 months, the treated side returned to basal scores. The residual effect seen in symmetry was due to an increase (18%) of motion in the paralyzed side. There was a significant decrease in the action potential of muscles on the nonparalyzed side 1 month post injection but completely reverted after 6 months. The Physical Function Index increased, but not significantly. The Social/Well-Being Function Index showed a significant increase at 6 months compared to pretreatment.

Conclusion

The proposed treatment improved facial symmetry for up to 6 months. Even after the end of the clinical effect of the drug, the paralyzed side’s clinical score was 18% higher than pretreatment, with an increased quality of life.

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Acknowledgments

The authors thank J. Falcetti Arte e Comunicação Médica Ltda. for kindly creating Fig. 2 on which botulinum toxin points were marked.

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Authors and Affiliations

  1. Division of Plastic Surgery, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

    Alessandra Grassi Salles, Paula Nunes Toledo & Marcus Castro Ferreira

  2. Rua Joaquim Floriano 466, cj. 2102, São Paulo, SP, 04534-002, Brazil

    Alessandra Grassi Salles

Authors
  1. Alessandra Grassi Salles
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  2. Paula Nunes Toledo
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  3. Marcus Castro Ferreira
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Correspondence to Alessandra Grassi Salles.

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Salles, A.G., Toledo, P.N. & Ferreira, M.C. Botulinum Toxin Injection in Long-Standing Facial Paralysis Patients: Improvement of Facial Symmetry Observed up to 6 Months. Aesth Plast Surg 33, 582–590 (2009). https://doi.org/10.1007/s00266-009-9337-9

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  • DOI: https://doi.org/10.1007/s00266-009-9337-9

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