clinical use of botulinum toxin n.
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Clinical Use of Botulinum Toxin . Song, Min-Seok. Good Morning. 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. History. Botulus, Greek

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Presentation Transcript
introduction
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
history
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
basic science
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
mechanism
Mechanism
  • Binding
  • Internalization
  • Membane Translocation
  • Protease activity
  • Recovery
preparation
Preparation
  • Botulinum Toxin Type A

1) Botox(Allergan)

2) Dysport(Ipsen)

  • Myobloc Botulinum Toxin type B(Elan)
reconstitution
Reconstitution
  • Sterile unpreserved saline
  • 1½-inch 25G needle
  • ½-inch 30G needle inj.
storage
Storage
  • 2-8(degree) Celsius
  • 12 Hours up to 30 days
indication
Indication
  • Aesthetic

Glabellar complex

Orbicularis oculi

Frontalis

Platysma

Other facial muscles

Combined with other procedure

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Other

Soft ts. Augmentation

Facial N. disorders

Parotid G. fistula

Headache

Hyperhidrosis

Frey’s syndrome

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Investigative

Wound healing

contraindication
Contraindication
  • Hypersensitvity to Albumin
  • Neuromuscular ds.
  • Pt. Treated with aminogycosides, penicillamine, quinine, Ca channel blockers
  • Preg./Lactation
  • Pt. On anticoagulation therapy
  • Poor psychological adjustment
complication
Complication
  • Local
  • Immunologic
  • Systemic
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Facial rejuvenation;

loss of facial expression

incomplete m. paralysis

unwanted m. paralysis

therapeutic failure
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

cinical use
Cinical Use
  • Rhytides
  • Facial Contour
  • Body Contour
  • Hyperhidrosis
  • Etc.
consideration
Consideration
  • Muscular anatomy
  • Potential Complication
  • Injection Technique
facial contouring
Facial Contouring
  • Gonial Angle
  • Bigonial Distance
  • Prominent Zygoma
  • Bony Prominence
  • Bony Asymmetry
  • Unrealistic Expectation
facial rhytides
Facial Rhytides
  • Frontalis
  • Grabella
  • Crow’s feet
  • Etc.
summary
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