The role of botulinum toxin a in the establishment of symmetry in pediatric paralysis of the lower lip.
OBJECTIVE
Botulinum toxin A has been described as an effective adjunct treatment for achieving symmetry in adults with facial paralysis. Few investigators have described the use of botulinum toxin A in pediatric patients with facial paralysis.


OBJECTIVE
To present our preliminary experience with botulinum toxin A in pediatric patients presenting with asymmetry of the lower lip.


METHODS
We performed a retrospective medical record review of all pediatric patients (age range, 4-17 years; mean [SD] age, 11.2 [4.7] years) with facial paralysis who were treated with botulinum toxin A injections from January 1, 2004, through December 31, 2012. Patients presented for treatment at The Hospital for Sick Children, Toronto, Ontario, Canada, or the Massachusetts Eye and Ear Infirmary, Boston.


METHODS
Using facial analysis software, we measured lower lip asymmetry in the patients' photographs before and after treatment, at rest, and in a dynamic state. We performed analysis of variance to assess for improvement in symmetry.


RESULTS
We identified 18 patients with the following 3 primary indications for treatment: focal lip asymmetry (n = 11), extensive hemifacial asymmetry (n = 5), and focal synkinesis (n = 2). We found no complications related to botulinum toxin A treatment. The mean (SD) dynamic deviation before the injection was 3.5 (1.7) mm, whereas the mean dynamic deviation after the injection was 1.5 (0.8) mm. The mean (SD) deviation correction was evaluated at 61% (6%) and was statistically significant (P = .04).


CONCLUSIONS
Botulinum toxin A injection is a safe procedure for improving localized asymmetry in pediatric patients with facial paralysis. Preliminary results indicate that botulinum toxin A may be an effective treatment for lower lip asymmetry in children and adolescents.


METHODS
4.
Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada2Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Siba
S
Haykal
Department of Plastic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Ehud
E
Arad
Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada2Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Shaghayegh
S
Bagher
Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada2Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Carolyn
C
Lai
Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Boston.
Marc
M
Hohman
Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Boston.
Tessa
T
Hadlock
Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada2Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Ronald M
RM
Zuker
Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada2Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Gregory H
GH
Borschel
D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005149:Facial Expression; D005158:Facial Paralysis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008046:Lip; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A