title: Botulinum toxin type A in the healing of ulcer following oro-mandibular dyskinesia in a patient in a vegetative state.
abstract: OBJECTIVE
  Use of botulinum toxin is expanding as clinical studies demonstrate new potential therapeutic applications. In rehabilitation, botulinum toxin is predominantly used as adjunct therapy for the treatment of spasticity, but it may prove useful for other atypical clinical situations.
  
  
  METHODS
  A 73-year-old man had a severe sub-arachnoid haemorrhage following the rupture of a giant aneurism of the middle left cerebral artery. Clinically, the patient presented a vegetative state and an oro-mandibular dyskinesia that produced a chronic ulcer on the lower lip. As treatment for this dyskinesia, a total of 320 U botulinum toxin type A were injected into the upper and lower orbicularis oris and masseter muscles.
  
  
  CONCLUSIONS
  This treatment allowed for application of topical medication and subsequently, ulcer healing. Botulinum toxin type A may be an important therapeutic aid for clinicians faced with treating persistent pathological conditions caused by dyskinesia.
authors.affiliation: Department of Neuro-Rehabilitation, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo FG, Italy. d.intiso@operapadrepio.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Intiso
authors.forename: Mario
authors.initials: M
authors.lastname: Basciani
authors.forename: Filomena
authors.initials: F
authors.lastname: Di Rienzo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Tolfa
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Grimaldi
authors.forename: Piero
authors.initials: P
authors.lastname: Fiore
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D020820:Dyskinesias / Q000150:complications / Q000503:physiopathology; D006801:Humans; D008047:Lip Diseases / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008410:Masticatory Muscles / Q000187:drug effects / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019226:Oral Ulcer / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D018458:Persistent Vegetative State / Q000150:complications / Q000503:physiopathology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A