STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 53

pathological. There is a no doubt that we can address a variety of situations with botulinum toxin and thus avoid a complicated surgical intervention, but it is necessary to know the wholecontext and especially to make an exact precise application. The botulinum toxin application could be effectively used to fix temporary faults (Bell`s palsy) or otherwise unmanageable situations (hemifacial spasm). It is advisable to proceed with minimum doses for individual muscles and eventually after two weeks, when the full effect becomes visible, to increase the dosage if necessary. The use of botulinum toxin for the treatment of temporary Bell's palsy in the facial nerve 13 is especially well documented. The application to the healthy half of the face will prevent "dragging" of the affected part, which reduces the aesthetic traumatization of the patient and helps prevent along with the rehabilitation the permanent consequences. 13 If the restoration of full symmetry is not reached, the botulinum toxin can be used to compensate for the different permanent muscle tone. This application is covered by health insurance in many European countries, so we have restricted limits to try this opportunity in the situation when the pandemic herpes virus probably causes this disease. 14 This indication belongs to the competence of oral or facial surgeon. 4.1.3. Applications to the Masseter muscle (especially therapy of bruxism) Until recently, the only acknowledged indications of the botulinum toxin in the jaw muscle were for the purpose of hernia treatment caused by impairment fascia when the surgical intervention was not easy or nearly impossible. However, recently the botulinum toxin has been applied to jaw muscle in higher doses repeatedly over longer time in order to cause a permanent volume muscle reduction and perhaps even the medial mandibular reconstruction in order to change the shape of the face from a square or box to oval. 15 This treatment is popular in Asia and has recently become more popular in Europe too. Figure 2. Points for application in therapy of bruxism. Stomatology Edu Journal The more relevant application is into the Masseter muscle and the medial pterygoid muscle to fix bruxism, where we do not have many other successful alternatives (Fig. 2). 16 Furthermore, apart from the expected temporary effect, a permanent result has been observed even after only single application, since in some cases the brain stops to project different psychological problems into the hyperfunction of discarded muscles. The therapy of the psychological problems by a competent professional should go hand in hand with the application of botulinum toxin. The application of the Botulinum toxin serves to (a) inhibit hypertonicity, (b) enhance the action of the antagonistic muscles, and (c) avoid an impingement to reestablish "the balance of forces". It is, however, necessary to emphasise that it involves a relatively high dose of botulinum toxin to each side of the face at least 3-4 times a year. 17 For a short-term treatment, it is an elegant method, for a long-term treatment the cost becomes expensive. We have no evidence of the long-term effect on the volume reduction and reshaping of the Masseter muscle on the long-term health of the orofacial system. It is, therefore, necessary to inform patients about a lack of publications that are now available and related to uncertain risks. The applications must be carried out very precisely to avoid damaging the facial nerve and parotid duct. Exact training can minimize these risks to zero. The application of the botulinum toxin to the Masseter muscle can also address some other rare syndromes and symptoms such as myalgia bite, "the symptom of first bite pain" and oromandibular dystonia. 18 The possible failure of this method was experienced in our department only due to under-dose. Due to the size of the Masseter muscle, the application of the botulinum toxin is usually up to five times higher than into facial muscles in aesthetic indications. 4.1.4. The syndrome of the temporomandibular joint This treatment modality combines applications into the Pterygoideus lateral and the Masseter muscle. 19 The appropriate indications are for patients with Effective applications of botulinum toxin in dentistry and in head and neck surgery Figure 3. Points for application in treatment of TMJ. 203