Botulinum toxin in facial palsy: an effective treatment for contralateral hyperkinesis.
BACKGROUND
The treatment of facial paralysis aims to recover symmetry in both static and dynamic states, which are seriously affected by the progressive contralateral hyperkinesis. Botulinum toxin may be used to reduce facial asymmetry in patients suffering from facial paralysis.


METHODS
Eighteen patients (12 female and six male patients) with facial palsy and contralateral hyperkinesis were injected with 112.5 units (0.9 ml) of Dysport (botulinum toxin type A) distributed evenly in the muscles of the perioral area. The patients were examined at 14, 28, 42, 56, 90, 150, and 180 days after the injection. Patients evaluated the degree of improvement at each time point. In addition, three evaluators made static (relaxed state) and dynamic (maximum contraction while smiling) assessments using a series of measurements obtained with a digital caliper, and the mean was used as the reference value.


RESULTS
The quantitative analysis demonstrated a significant reduction in hyperkinesis that lasted approximately 180 days. There was a significant or moderate improvement in most of the cases. All of the patients were very satisfied with the treatment. Adverse events were short-lived (mainly during the first 15 days) and related to difficulty in drinking without liquid loss (nine of 18) and difficulty in chewing without food loss (three of 18).


CONCLUSIONS
Injection of botulinum toxin was effective in reducing muscular hyperkinesis in the hemiface opposite that affected by facial paralysis, with mild and short-term side effects.
de Maio
Maurício
M
São Paulo, Brazil From the Department of Otolaryngology, Faculty of Medicine, University of São Paulo.
Bento
Ricardo Ferreira
RF
D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005158:Facial Paralysis / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006948:Hyperkinesis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017060:Patient Satisfaction; D013997:Time Factors; D016896:Treatment Outcome