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Botulinum Toxin Injection in Facial Paralysis and Other Neuromuscular Conditions

  • Use of Botulinum Toxin in Otorhinolaryngology (A D’Souza and CL Ng, Section Editors)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Botulinum toxin A (BTX-A) has long been used for the management of the sequelae of facial paralysis and other neuromuscular conditions. Evidence is limited in its efficacy and outcomes, and there is a lack of standardisation in its use.

Recent Findings

Both objective and subjective outcomes in BTX-A injections for facial paralysis are favourable. Differences are seen depending on type of botulinum toxin used, but most studies recommend OnabotulinumtoxinA.

Summary

BTX-A injection is an effective method in the treatment of these disorders, improving patient outcomes through a minimally invasive approach. There is however a paucity of randomised control trials and standardisation of protocols of its use.

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Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Royal National ENT and Eastman Dental Hospitals, 47-49 Huntley Street, London, WC1E 6DG, UK

    Henry Zhang, Alfonso Luca Pendolino, Shakeel R. Saeed & Peter Andrews

  2. Ear Institute, University College London, 332 Grays Inn Road, London, WC1X 8EE, UK

    Alfonso Luca Pendolino, Shakeel R. Saeed & Peter Andrews

Authors
  1. Henry Zhang
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  2. Alfonso Luca Pendolino
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  3. Shakeel R. Saeed
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  4. Peter Andrews
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Correspondence to Henry Zhang.

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This article is part of the Topical collection on Use of Botulinum Toxin in Otorhinolaryngology

Appendix 1

Appendix 1

The senior authors (SRS and PA) have routinely used Dysport® botulinum toxin in their clinical practice for over 20 years. The standard Dysport® vial contains 500 units of the toxin as a dried pellet. This is reconstituted with slow injection and gentle agitation of 1 ml of sterile normal (0/9%) saline (rapid injection into the vial or rigorous shaking can denature the toxin). This gives a solution of 500 units per ml. Fine needle 1-ml diabetic syringes are used to draw up the solution prior to injection. These syringes have 0.1 ml and 0.01 ml gradations which allow incremental injection of 5 units. This works well for the majority of indications for facial palsy sequelae whereby between 10 and 30 units of Dysport® are required depending on the muscle being injected. This concentration of the toxin also means that small volumes are utilised, reducing the risk of diffusion into adjacent muscles and unwanted side-effects. The injection site(s) and doses are recorded on a standard proforma, which comprised of a schematic of the face with recording of the injection sites and doses at each site. Recordings were taken at each visit thereby allowing adjustment of dose and site at subsequent visits depending on clinical response.

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Zhang, H., Pendolino, A.L., Saeed, S.R. et al. Botulinum Toxin Injection in Facial Paralysis and Other Neuromuscular Conditions. Curr Otorhinolaryngol Rep 8, 364–368 (2020). https://doi.org/10.1007/s40136-020-00306-6

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  • DOI: https://doi.org/10.1007/s40136-020-00306-6

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