Use of Botulinum Toxin in Orofacial Clinical Practice

Maria-Angeles Serrera-Figallo, Gonzalo Ruiz-de-León-Hernández, Daniel Torres-Lagares, Alejandra Castro-Araya, Omar Torres-Ferrerosa, Esther Hernández-Pacheco, Jose-Luis Gutierrez-Perez, Maria-Angeles Serrera-Figallo, Gonzalo Ruiz-de-León-Hernández, Daniel Torres-Lagares, Alejandra Castro-Araya, Omar Torres-Ferrerosa, Esther Hernández-Pacheco, Jose-Luis Gutierrez-Perez

Abstract

Introduction: Botulinum neurotoxin (BoNT) is a potent biological toxin and powerful therapeutic tool for a growing number of clinical orofacial applications. BoNT relaxes striated muscle by inhibiting acetylcholine's release from presynaptic nerve terminals, blocking the neuromuscular junction. It also has an antinociceptive effect on sensory nerve endings, where BoNT and acetylcholine are transported axonally to the central nervous system. In dentistry, controlled clinical trials have demonstrated BoNT's efficiency in pathologies such as bruxism, facial paralysis, temporomandibular joint (TMJ) disorders, neuropathic pain, sialorrhea, dystonia and more.

Aim: This study's aim was to conduct a systematic literature review to assess the most recent high-level clinical evidence for BoNT's efficacy and for various protocols (the toxin used, dilution, dosage and infiltration sites) used in several orofacial pathologies.

Materials and methods: We systematically searched the MedLine database for research papers published from 2014 to 2019 with randomly allocated studies on humans. The search included the following pathologies: bruxism, dislocation of the TMJ, orofacial dystonia, myofascial pain, salivary gland disease, orofacial spasm, facial paralysis, sialorrhea, Frey syndrome and trigeminal neuralgia.

Results: We found 228 articles, of which only 20 met the inclusion criteria: bruxism (four articles), orofacial dystonia (two articles), myofascial pain (one article), salivary gland disease (one article), orofacial spasm (two articles), facial paralysis (three articles), sialorrhea (four articles) or trigeminal neuralgia (three articles).

Discussion: The clinical trials assessed showed variations in the dosage, application sites and musculature treated. Thus, applying BoNT can reduce symptoms related to motor muscular activity in the studied pathologies efficiently enough to satisfy patients. We did not identify the onset of any important side effects in the literature reviewed. We conclude that treatment with BoNT seems a safe and effective treatment for the reviewed pathologies.

Keywords: Frey syndrome; botulinum toxin; bruxism; facial paralysis; facial spasm; lockjaw; myofascial pain; orofacial dystonia; salivary fistula; sialorrhea; trigeminal neuralgia.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Safety limits for infiltration of the masseter: The upper limit is the commissure line to the earlobe (above the Stenon duct location). The anterior limit is the anterior edge of the masseter (the risorio muscle is in this area). The lower limit is the jaw’s lower edge. The posterior boundary is the masseter’s posterior border (the parotid gland).
Figure 2
Figure 2
Guidelines for infiltrating major and minor zygomatic muscles. 1, line parallel to the nasal base; 2, line passing through the oral corner starting from the eye’s outer edge; 3, line perpendicular to one part of the eye’s outer edge. Infiltration points: (A) zygomatic minor point, (B) zygomatic major infiltration point. Dose per point = 2 U.
Figure 3
Figure 3
Evolution of spasm pre- (top) and post-treatment of two major and minor zygomatic points at 2 U per point (bottom).

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