ASOPRSFall Scientific SymposiumSyllabus
161
T8
TreatingBuccinator withBotulinumToxin inPatientswithFacial Synkinesis—
APreviouslyOverlookedTarget
JacquelineDiels, OT
1
, LeslieAWei,MD
2
,Mark J Lucarelli,MD, FACS
2
.
1
Neuromuscular RetrainingClinic, University ofWisconsin -
Madison,Madison,WI, UnitedStates,
2
Oculoplastic, Facial Cosmetic, &Orbital Surgery, University ofWisconsin -Madison,
Madison,WI, UnitedStates
Introduction:
Synkinesis after facial nerve injury produces functional and cosmetic concerns for patients.The purpose of this study
is to review our experience of treating buccinator synkinesiswith botulinum toxin.
Methods:
Thiswas a retrospectivemedical records review.All patients seen at the University ofWisconsinNeuromuscular Retraining
Clinicwhowere treatedwith botulinum injections to the buccinatormusclewere included.After a period of neuromuscular retraining
lasting 6-12months, botulinum injectionswere administered to themid and/or posterior aspect of buccinator by the senior author
via an intra-oral approach.The sites and dosage of the injections depended substantially on input from the therapist (JD) overseeing
the patient’s neuromuscular retraining therapy. Data on patient age, gender, indication for treatment, location and dose of botulinum
administration, and outcomewere collected and analyzed.The SynkinesisAssessment Questionnaire (SAQ) was utilized as a patient-
reported outcomemeasure. Descriptive statisticswere computed for all recorded variables.
Results:
A total of 40 patientswith synkinesis involving buccinator were treated. Female tomale ratiowas 9:1.The indications
for treatment included: significant retraction and immobility of the affected oral commissure at rest and during volitional and
spontaneous facial expressions, difficultymanipulating food duringmastication, and biting the inside of the affected cheek.Average
age at first treatment was 53 years old (range 18-83).Mean total dose of botulinum administered per sessionwas 2.0 units (range
1.25- 2.5 units). Follow-up ranged from 1 to 18months. SAQ scores improved frommean of 66.3 (33-88.8) preinjection to 49.5
(28.8-71.1) post injection.Two patientswere bothered by temporary increased flaccidity of the cheek. In general, patient satisfaction
with the procedurewas high.
Conclusions:
To our knowledge, this is the first report of treatment of buccinator synkinesiswith botulinum toxin.This treatment has
become a valuable adjunct in our comprehensivemanagement of patientswith facial synkinesis.
References:
1. Couch SM, Chundury RV, Holds JB. Subjective and objective outcomemeasures in treatment of facial nerve
synkinesiswith onabotulinumtoxinA (Botox). Ophthal Plast Reconstr Surg. 2014; 30: 246-250.
2. Lindsay RW. RobinsonM, andHadlockTA. Comprehensive facial rehabilitation improves facial function in patientswith facial
paralysis. Physical Ther. 2010, 90: 391-397.
3.Mehta RP,WernickRobinsonM, HadlockTA.Validation of the SynkinesisAssessment Questionnaire. Laryngoscope. 2007;
117: 923-6.
4. Laskawi R, DamenzW, Roggenkämper P, BaetzA. Botulinum toxin treatment in patientswith facial synkinesis. Eur Arch
Otorhinolaryngol. 1994:S195-9.
DetailedProgram
—Thursday,October 16, 2014
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