title: Self-mutilation of the lower lip in a child with dystonia secondary to megalencephalic leukoencephalopathy treated with botox injections: a case report.
abstract: OBJECTIVE
  We report the case of a 10-year old boy who had been diagnosed with megalencephalic leukoencephalopathy several years earlier. Because of the patient's oral dystonic activity, a traumatic, nonhealing, chronic ulcer had developed on his lower lip.
  
  
  METHODS
  Botox-A was injected into the mentalis, orbicularis oris, and bilateral masseter muscles.
  
  
  RESULTS
  The patient showed decreased dystonia and gradual complete healing of the traumatic ulcer of the lower lip.
  
  
  CONCLUSIONS
  The treatment of patients with self-mutilation to the lips will often be difficult. Traditionally, patients have been treated with various medications, oral appliances, and even tooth extraction. The results of the present case report suggest that Botox should be considered as a possible first-line strategy, along with oral appliances.
authors.affiliation: Department Chair, Oral and Maxollifacial Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Fantuzzo
authors.affiliation: Resident, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY. Electronic address: james_roger@urmc.rochester.edu.
authors.forename: James M
authors.initials: JM
authors.lastname: Rogér
authors.affiliation: Private Practice, Pennsylvania.
authors.forename: Meghan D
authors.initials: MD
authors.lastname: Barroner
authors.affiliation: Associate Professor, University of Minnesota School of Dentistry, Minneapolis, MN.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Karp
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D004421:Dystonia / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D056784:Leukoencephalopathies / Q000150:complications*; D008046:Lip / Q000293:injuries*; D008297:Male; D058627:Megalencephaly / Q000150:complications*; D012652:Self Mutilation
chemical_list: D019274:Botulinum Toxins, Type A