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.
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