Botulinum toxin in the treatment of first bite syndrome

Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA.
Otolaryngology Head and Neck Surgery (Impact Factor: 2.02). 12/2008; 139(5):742-3. DOI: 10.1016/j.otohns.2008.08.015
Source: PubMed
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    • "Finally, some authors [12] [13] proposed intraparotid injections of botulinum toxin type A, which is a cholinergic receptor blocker. Lee et al. [12] observed a reduction of the severity of pain and a marked improvement of quality of life. Ali et al. [13] reported an even more dramatic effect in one patient with almost complete resolution of the syndrome in less than 48 h, with no recurrence of symptoms over a 10-week period after the injection. Conversely, one patient treated with acupuncture seemed to receive no benefits from it. "
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    ABSTRACT: First bite syndrome (FBS) is an early postoperative pain syndrome characterized by the sudden onset of pain in the parotid region at the first bite of each meal. The etiology is not certain, hence a standardized therapy does not exist. A 50-year old woman referred to us complaining of a swelling in the right parotid region. Fine-needle aspiration biopsy (FNAB) was diagnostic for pleomorphus adenoma of the deep lobe of the parotid gland. A 50-year old man presented with a mass in the right side of the neck, FNAB was diagnostic for parapharyngeal space neurinoma. The first patient was submitted to total parotidectomy with facial nerve preservation, the second to extracapsular dissection of the tumor. A week after surgery both patients developed FBS. A qualitative/quantitative description of pain was obtained by means of a self-coded questionnaire. The score ranges from 8 to 44, corresponding to the lowest and the highest discomfort possible, respectively. Acupuncture was used to treat these 2 patients. The treatment protocol comprised 6 sessions, one per week, lasting 30 minutes each. Our questionnaire was administered before and after treatment and the score dropped from 33 to 25 in the female, from 30 to 15 in the male patient. FBS is a complication of upper cervical surgery with a high morbidity rate. We describe the first two cases of FBS that were successfully treated with acupuncture in our ENT department. We believe that this procedure may represent a valid therapeutic alternative in the future. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of otolaryngology 01/2015; 36(3). DOI:10.1016/j.amjoto.2015.01.023 · 0.98 Impact Factor
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    • "ensitivity is thought to elicit a maximal contraction of myoepithelial cells during the first bite of a meal that subsides with continued masticatory action . The concept that pain is elicited ultimately by myoep - ithelial contraction led to the hypothesis that paralysis of these myoepithelial filaments with BTX may relieve FBS symptoms . In 2008 Ali et al . ( 2008 ) reported the first documented use of BTX in the treatment of FBS , thereby adding another applica - tion of Botox in the medical field . The operative procedure involves placing the patient in supine position and infiltrating the area some local anesthetic . The area where the patient feels the most intense pain is marked preoperative"
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    ABSTRACT: The aim of this article is to review the mechanism of action, physiological effects, and therapeutic applications of botulinum neurotoxins in the head and neck area.Study designAn extensive literature search was performed using keywords. The resulting articles were analyzed for relevance in four areas: overview on botulinum neurotoxins, the role of botulinum neurotoxins in the management of salivary secretory disorders, the role of botulinum neurotoxins in the management of facial pain, and the role of botulinum neurotoxins in head and neck movement disorders. Institutional review board approval was not needed due the nature of the study.ResultsBotulinum neurotoxin therapy was demonstrated to be a valuable alternative to conventional medical therapy for many conditions affecting the head and neck area in terms of morbidly, mortality, and patient satisfaction with treatment outcomes.Conclusion Botulinum neurotoxin therapy provides viable alternatives to traditional treatment modalities for some conditions affecting the head and neck region that have neurological components. This therapy can overcome some of the morbidities associated with conventional therapy. More research is needed to determine the ideal doses of botulinum neurotoxin to treat different diseases affecting the head and neck regions.KeywordsBotulinum toxinBotoxTemporomandibular disorderDystoniaFacial pain
    Saudi Dental Journal 01/2015; 27(1). DOI:10.1016/j.sdentj.2014.10.001
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    • "It is probably due to autonomic dysfunction of salivary myoepithelial cells. Intraparotid Botox injection was found to significantly decrease symptom severity and improve the patients’ QoL in a case series of five patients and a case report [4].40,41 "
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    ABSTRACT: Botulinum toxin (Botox) is an exotoxin produced from . It works by blocking the release of acetylcholine from the cholinergic nerve end plates leading to inactivity of the muscles or glands innervated. Botox is best known for its beneficial role in facial aesthetics but recent literature has highlighted its usage in multiple non-cosmetic medical and surgical conditions. This article reviews the current evidence pertaining to Botox use in the head and neck. A literature review was conducted using The Cochrane Controlled Trials Register, Medline and EMBASE databases limited to English Language articles published from 1980 to 2012. The findings suggest that there is level 1 evidence supporting the efficacy of Botox in the treatment of spasmodic dysphonia, essential voice tremor, headache, cervical dystonia, masticatory myalgia, sialorrhoea, temporomandibular joint disorders, bruxism, blepharospasm, hemifacial spasm and rhinitis. For chronic neck pain there is level 1 evidence to show that Botox is ineffective. Level 2 evidence exists for vocal tics, trigeminal neuralgia, dysphagia and post-laryngectomy oesophageal speech. For stuttering, 'first bite syndrome', facial nerve paresis, Frey's syndrome, oromandibular dystonia and palatal/stapedial myoclonus the evidence is level 4. Thus, the literature highlights a therapeutic role for Botox in a wide range of non-cosmetic conditions pertaining to the head and neck (mainly level 1 evidence). With ongoing research, the spectrum of clinical applications and number of people receiving Botox will no doubt increase. Botox appears to justify its title as 'the poison that heals'.
    02/2013; 4(2):10. DOI:10.1177/2042533312472115
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