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Clinical Use of Botulinum Toxin

Clinical Use of Botulinum Toxin

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Clinical Use of Botulinum Toxin

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  1. Clinical Use of Botulinum Toxin Song, Min-Seok

  2. Good Morning

  3. Introduction • Botulinum Toxin acts by blocking ACH release from nerve terminals at the neuromuscular junction • Discovery in 1897 • Therapeutic agent in 1977 • Today, versatile clinical tool

  4. History • Botulus, Greek • Van Ermengen in 1895 • Alan Scott in the late 1960s • Human volunteers in 1977 • FDA approval in 1989 • Expanded use in late 2000

  5. Basic Science • Produced by bacteria (exotoxin of Clostridium Botulinum, G(+), anaerobic, spore-forming) • 8 serotypes(A-G) • Similar structure - light chain linked by a disulfide bond to a heavy chain • Type A is available

  6. Mechanism • Binding • Internalization • Membane Translocation • Protease activity • Recovery

  7. Preparation • Botulinum Toxin Type A 1) Botox(Allergan) 2) Dysport(Ipsen) • Myobloc Botulinum Toxin type B(Elan)

  8. Reconstitution • Sterile unpreserved saline • 1½-inch 25G needle • ½-inch 30G needle inj.

  9. Storage • 2-8(degree) Celsius • 12 Hours up to 30 days

  10. Indication • Aesthetic Glabellar complex Orbicularis oculi Frontalis Platysma Other facial muscles Combined with other procedure

  11. Other Soft ts. Augmentation Facial N. disorders Parotid G. fistula Headache Hyperhidrosis Frey’s syndrome

  12. Investigative Wound healing

  13. Contraindication • Hypersensitvity to Albumin • Neuromuscular ds. • Pt. Treated with aminogycosides, penicillamine, quinine, Ca channel blockers • Preg./Lactation • Pt. On anticoagulation therapy • Poor psychological adjustment

  14. Complication • Local • Immunologic • Systemic

  15. Facial rejuvenation; loss of facial expression incomplete m. paralysis unwanted m. paralysis

  16. Therapeutic failure • presence of circulating neutralizing antibodies ; correlated with numbers of inj., length of Tx., total cumulative dose • Psychological ; unprepared to the paralysis and changes of face

  17. Cinical Use • Rhytides • Facial Contour • Body Contour • Hyperhidrosis • Etc.

  18. Consideration • Muscular anatomy • Potential Complication • Injection Technique

  19. Facial Contouring • Gonial Angle • Bigonial Distance • Prominent Zygoma • Bony Prominence • Bony Asymmetry • Unrealistic Expectation

  20. Facial Rhytides • Frontalis • Grabella • Crow’s feet • Etc.

  21. Summary • Transient and nondestructive • Graded by varying dose and frequency of injections • Safety • Autonomic disorders and control of pain are being explored • Primarily treatment of hyperfunctional muscle disorder • No standard dose and injection strategy

  22. END