Clinical Use of Botulinum Toxin

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Clinical Use of Botulinum Toxin

• Song, Min-Seok

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Good Morning
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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

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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

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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

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Mechanism

• Binding
• Internalization
• Membane Translocation
• Protease activity
• Recovery

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Preparation

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

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Reconstitution

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

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Storage

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

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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
• Freys syndrome

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• Investigative
• Wound healing

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Contraindication

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

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Complication

• Local
• Immunologic
• Systemic

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• Facial rejuvenation
• loss of facial expression
• incomplete m. paralysis
• unwanted m. paralysis

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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

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Cinical Use

• Rhytides
• Facial Contour
• Body Contour
• Hyperhidrosis
• Etc.

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Consideration

• Muscular anatomy
• Potential Complication
• Injection Technique

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Facial Contouring

• Gonial Angle
• Bigonial Distance
• Prominent Zygoma
• Bony Prominence
• Bony Asymmetry
• Unrealistic Expectation

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Facial Rhytides

• Frontalis
• Grabella
• Crows feet
• Etc.

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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

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