![]() ![]() 43 More recently, EMG-guided Botox administration that chemically denervates the cricopharyngeus muscle facilitating tracheoesophageal speech and relieving dysphagia has been reported. 42 Traditionally, this was treated with dilation of the pharyngo-oesophageal segment (POS), pharyngeal myotomy and/or pharyngeal neurectomy. However, postoperative pharyngo-oesophageal spasm can cause failure of tracheoesophageal speech and dysphagia. The procedure involves cricopharyngeal myotomy and valve placement. Tracheoesophageal puncture in laryngectomy patients allows excellent quality speech development in most cases. 24 It is worth noting that Botox not only reduces abnormal movements and contractures but can also prevent secondary degenerative changes of the cervical spine and associated radiculopathy. Since then, there have been further RCTs confirming the efficacy and safety of Botox in the treatment of cervical dystonia in both previously treated as well as Botox-naive patients. 22, 23 These meta-analyses showed that single injection of Botox is effective (as evident from both objective and subjective rating scales) and can be safely repeated if necessary. 21 The evidence supporting the use of Botox in the treatment of cervical dystonia consists of two Cochrane systematic reviews of 13 (677 participants for Botox A) and three (308 participants for Botox B) high-quality RCTs, respectively. It can be primary or secondary to other neurological disorders. This refers to sustained neck muscle contraction resulting in involuntary movements of the head and neck associated with significant cervical pain and abnormal cervical postures. This review examines the evidence on Botox usage in non-cosmetic conditions of the head and neck.Ĭervical dystonia or spasmodic torticollis This has been aided by a greater understanding of its underlying physiology as well as improved efficacy and safety. Recently, the therapeutic uses of Botox have expanded exponentially to include a wide range of medical and surgical conditions. Nine years later, the cosmetic effects of the toxin on wrinkles were noted, but it was only in 2002, following Food and Drug Administration approval, that Botox gained widespread popularity as an alternative to cosmetic surgery. Its first medical use was to treat strabismus in 1980. Botox is one of the most potent naturally occurring biological poisons and in the past has been responsible for many accidental deaths prior to its discovery in medicine. Its effects are transient and may be graded by varying the dose and frequency of administration. ![]() It works by blocking the release of acetylcholine from cholinergic nerve endings causing inactivity of muscles or glands. Botox appears to justify its title as ‘the poison that heals’.īotulinum toxin (Botox) is a protease exotoxin produced from Clostridium botulinum. With ongoing research, the spectrum of clinical applications and number of people receiving Botox will no doubt increase. Thus, the literature highlights a therapeutic role for Botox in a wide range of non-cosmetic conditions pertaining to the head and neck (mainly level 1 evidence). For stuttering, ‘first bite syndrome’, facial nerve paresis, Frey's syndrome, oromandibular dystonia and palatal/stapedial myoclonus the evidence is level 4. Level 2 evidence exists for vocal tics, trigeminal neuralgia, dysphagia and post-laryngectomy oesophageal speech. For chronic neck pain there is level 1 evidence to show that Botox is ineffective. The findings suggest that there is level 1 evidence supporting the efficacy of Botox in the treatment of spasmodic dysphonia, essential voice tremor, headache, cervical dystonia, masticatory myalgia, sialorrhoea, temporomandibular joint disorders, bruxism, blepharospasm, hemifacial spasm and rhinitis. A literature review was conducted using The Cochrane Controlled Trials Register, Medline and EMBASE databases limited to English Language articles published from 1980 to 2012. This article reviews the current evidence pertaining to Botox use in the head and neck. ![]() Botox is best known for its beneficial role in facial aesthetics but recent literature has highlighted its usage in multiple non-cosmetic medical and surgical conditions. It works by blocking the release of acetylcholine from the cholinergic nerve end plates leading to inactivity of the muscles or glands innervated. ![]() Botulinum toxin (Botox) is an exotoxin produced from Clostridium botulinum. ![]()
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