Clinical Use of Botulinum Toxin Song, Min-Seok. Good Morning.
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Transcript of Clinical Use of Botulinum Toxin Song, Min-Seok. Good Morning.
Clinical Use of Botulinum Toxin
Song, Min-Seok
Good Morning
Introduction Botulinum Toxin acts by blocking ACH rel
ease from nerve terminals at the neuromuscular junction
Discovery in 1897 Therapeutic agent in 1977 Today, versatile clinical tool
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 Produced by bacteria (exotoxin of Clostri
dium 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 Binding Internalization Membane Translocation Protease activity Recovery
Preparation Botulinum Toxin Type A 1) Botox(Allergan) 2) Dysport(Ipsen)
Myobloc Botulinum Toxin type B(Elan)
Reconstitution Sterile unpreserved saline
1½-inch 25G needle
½-inch 30G needle inj.
Storage 2-8(degree) Celsius
12 Hours up to 30 days
Indication
Aesthetic Glabellar complex Orbicularis oculi Frontalis Platysma Other facial muscles Combined with other procedure
Other Soft ts. Augmentation Facial N. disorders Parotid G. fistula Headache Hyperhidrosis Frey’s syndrome
Investigative Wound healing
Contraindication Hypersensitvity to Albumin Neuromuscular ds. Pt. Treated with aminogycosides, penicill
amine, quinine, Ca channel blockers Preg./Lactation Pt. On anticoagulation therapy Poor psychological adjustment
Complication Local
Immunologic
Systemic
Facial rejuvenation; loss of facial expression incomplete m. paralysis unwanted m. paralysis
Therapeutic failure presence of circulating neutralizing antib
odies ; correlated with numbers of inj., length o
f Tx., total cumulative dose Psychological ; unprepared to the paralysis and change
s of face
Cinical Use Rhytides Facial Contour Body Contour Hyperhidrosis Etc.
Consideration Muscular anatomy
Potential Complication
Injection Technique
Facial Contouring Gonial Angle Bigonial Distance Prominent Zygoma Bony Prominence Bony Asymmetry Unrealistic Expectation
Facial Rhytides Frontalis Grabella Crow’s feet Etc.
Summary Transient and nondestructive Graded by varying dose and frequency of inject
ions Safety Autonomic disorders and control of pain are b
eing explored Primarily treatment of hyperfunctional muscle
disorder No standard dose and injection strategy
END