"The Mysterious Molecule of the Century"– such an epithet botulinum toxin deserved from the world neurological community in 2000.
Marina Ivanovna Soykher - Candidate of Medical Sciences, Chief Physician of the Moscow Regional Dental Polyclinic, Certified Trainer in the Use of Botulinum Toxin in Dental Practice
Perhaps, no drug in medicine is surrounded by so many unthinkable legends, tales, rumors and myths as botulinum toxin. What is not written about this drug in the international and domestic press: “addictive”, “poisons the brain”, “may harm the nervous system”, “kills brain cells, and as a result the intellect suffers”. Recently, botulinum toxin has undeservedly become the subject of numerous jokes – ostensibly as a means to create a face-mask. This happened because the original purpose of the mass application of neurotoxin in aesthetic medicine was to eliminate mimic wrinkles and create an ideal static picture of a face with smoothed wrinkles.
On the one hand, botulinum toxin is the cause of a severe infectious disease – botulism, on the other – a highly effective drug that is used in clinical practice for the treatment of more than 200 diseases. The entire history of the use of BTA in medicine – this is the expansion of indications for use, safety and efficacy studies, the selection of optimal therapeutic dosages, which becomes possible thanks to large-scale studies on the study of BTA around the world.
Botulinum toxin has undergone thousands of clinical trials over 30 years. More than 20,000 scientific papers, hundreds of scientific articles and manuals devoted to the clinical application of BTA have been published. Millions of patients worldwide have been successfully treated. This was the impetus for the development of such a field of medicine as botulinum therapy, which studies the theoretical foundations and mechanisms of action of botulinum toxin preparations, and also develops methods for treating various diseases with botulinum toxin, manifested by muscle spasm, pain and autonomic dysfunction. This is a young, but progressively dynamically developing field of general medicine, which is interdisciplinary in nature and unites doctors of almost all specialties.
Wide range of applications for botulinum toxin
Recently, botulinum toxin type A (BTA) preparations have been actively used not only in aesthetic medicine and neurology, but also in other areas of clinical medicine, such as dentistry, urology, gynecology, gastroenterology, ophthalmology, oncology, otolaryngology, orthopedics . The unique mechanism of action of BTA, the locality of action, the possibility of injection into any accessible area, the absence of systemic side effects and the long duration of action, proven on the basis of rigorous scientific studies, determine the therapeutic value of botulinum toxin.
Poison of Civilization
"Everything is poison and everything is medicine, and only measure makes one different" – this dictum fully applies to botulinum toxin, one of the most potent biological toxins discovered by Van Ermengen in 1895. Botulinum toxin can be called the poison of civilization, because it is thanks to the invention of long-term storage products that mankind owes an unpleasant acquaintance with clostridium botulinum. Clostridium botulinum bacteria produce seven different serotypes of toxins (A, B, C, D, E, F and G). All these serotypes inhibit the presynaptic release of the mediator, but their intracellular targets, mode of action and effectiveness differ.
Serotypes A and B
Only serotypes A and B are used to create therapeutic drugs.
Serotype A – the most studied. Based on it, pharmacological companies from different countries have created several commercial drugs. There are several preparations of botulinum toxin in the world, they are all based on the same neurotoxin molecule – Clostridium botulinum. Recently, it has been established that the genetic composition of BTA is heterogeneous – clusters A1-A4 were identified, which, according to preliminary data, may explain the differences in the therapeutic effect of BTA drugs in the future.
Many years of clinical experience has not only expanded the boundaries of indications for the use of BTA, but has enabled dermatologists, plastic surgeons, neurologists and doctors of other specialties to use this drug in their practice.
Constant refinement of the mechanism of action and improvement of methods from the standpoint of an individual approach to the patient opens up new opportunities for the therapeutic use of BTA, in particular, in aesthetic medicine. A vivid illustration of this is the modern clinical indications for the use of BTA in the head and face:
– hyperfunctional mimic wrinkles;
– facial oval correction (target muscles: m. platysma and m. masseter (massive lower jaw as a result of hypertrophy of the masticatory muscle proper);
– facial asymmetry due to neuropathy of the facial nerve (relaxation of hyperactive mimic muscles of the healthy side, effect on synkinesis and contractures of the affected side);
– prevention of the development of rough scars in case of facial injuries and after operations on the face and head;
– before reconstructive operations on the face and head in order to improve the survival rate of musculocutaneous flaps and reduce the risk of gross scarring;
– vegetative facial syndromes (Lucy Frey syndrome, erythrophobia, pathological lacrimation).
Botulinum toxin in dentistry
Among the most common complaints that patients come to an esthetician with, there is a disproportion of the face, in particular, the problem of the "square face". The contours and shape of the lower half of the face are determined by the relative position of the upper and lower jaws (occlusal ratio), the size and shape of the lower jaw, as well as the state of the masticatory muscles.
The functional state of the masticatory muscle is associated with the configuration of the lower third of the face and possible asymmetry, which masks a combination of dental and neurological problems that require a detailed examination and adequate treatment of the patient. These problems are solved at the intersection of neurological, dental and cosmetology specialties.
Some diseases, such as bruxism and oromandibular dystonia, are accompanied by hypertrophy of the masticatory muscles, which occurs as a result of their violent contraction, and their aesthetic manifestation is a massive lower third of the face. Excessive prolonged activity of the masticatory muscles leads to hypertrophy, which is characterized by an increase in strength and muscle mass.
Markers of masticatory muscle hypertonicity:
1. Increased tooth sensitivity.
2. Pathology of hard dental tissues.
3. Cracks and fractures.
4. Pathological abrasion of teeth.
5. Periodontal pathology.
6. TMJ dysfunction.
7. Hypertrophy of masticatory muscles.
8. Chips of ceramic crowns, fillings.
9. Compensatory hypertrophy of the periosteum in the area of the angles of the lower jaw.
A detailed analysis of the causes of the development of masticatory muscle hypertrophy – this is the basis for drawing up a treatment plan and a guaranteed positive prognosis. We must provide maximum information to our patients about the possible methods of aesthetic correction and their safety. Many years of positive experience with the use of BTA injections in the correction of masticatory muscle hypertrophy is an alternative to plastic surgery for resection of the angles of the lower jaw in case of masticatory muscle hypertrophy, as it allows for atraumatic correction without violating the integrity and function of the masticatory muscle. Improving the technique of BTA injections under EMG control makes it possible to take into account the state and reaction of antagonist and synergist muscles to the ongoing correction of the lower third of the face.
The main task in correcting masticatory muscle hypertrophy – do not interfere with chewing function. Therefore, the approach to choosing a correction technique should be based on the individual skeletal characteristics of the patient.
Standard scheme for correcting masticatory muscle hypertrophy
Total quantity of the drug – 100 units
Actually chewing muscle – 30 units on both sides.
Temporalis muscle (anterior, middle, posterior portion) – 20 units on both sides.
The question of BTA dosages and the duration of the muscle relaxant effect is still open. It is worth noting the tendency to search for the minimum effective dose of administered BTA. Our clinical experience with BTA injections under the control of surface EMG into masticatory muscles shows that a decrease in the dosage of BTA injection into masticatory and temporal muscles from 100 units. BTA up to 70 units BTA did not change the duration of the muscle relaxant effect.
Long-term follow-up of patients receiving BTA injections clearly showed the possibility of changing muscle (chewing and mimic) patterns and stereotypes. When correcting the hypertrophy of the masticatory muscle, we observed the solution of not only aesthetic, but also psychological problems in patients.
New algorithms for aesthetic face correction from the standpoint of individual characteristics allow achieving visual aesthetic-functional-predictable results.
According to biointerdent.ru
Share:
Add a comment