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Review
. 2024 Mar 20;16(3):161.
doi: 10.3390/toxins16030161.

Botulinum Toxin Injections to Manage Sequelae of Peripheral Facial Palsy

Fabienne Carré  1 , Jérémy Amar  1 , Frédéric Tankéré  1 , Claire Foirest  1
Affiliations
Review

Botulinum Toxin Injections to Manage Sequelae of Peripheral Facial Palsy

Fabienne Carré et al. Toxins (Basel). .

Abstract

Long-standing facial palsy sequelae cause functional, aesthetic, and psychological problems in patients. Botulinum toxin is an effective way to manage them, but no standardized recommendations exist. Through this non-systematic review, we aimed to guide any practitioner willing to master the ins and outs of this activity. We reviewed the existing literature and completed, with our experience as a reference center, different strategies of botulinum toxin injections used in facial palsy patients, including history, physiopathology, facial analysis, dosages, injection sites, and techniques, as well as time intervals between injections. The reader will find all the theorical information needed to best guide injections according to the patient's complaint, which is the most important information to consider.

Keywords: botulinum toxin; facial asymmetry; facial paresis; post paralytic facial spasm; sequelae; synkinesis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Botulinum toxin injection in the right lacrimal gland.
Figure 2
Figure 2
Injection into the buccinator muscle via the endobuccal route after highlighting the dental impression line on the jugal mucosa.
Figure 3
Figure 3
Palpation of the fibrous band of the DAO consistent with its hyperkinesis.
Figure 4
Figure 4
Patient with debilitating hyperkinesis and synkinesia in the mentalis, plastyma and DAO, responsible for asymmetry of the lower third of the face when smiling. Dose and site of botulinum toxin injection protocol suggestion. Black cross (4 UI) for platysma, blue star (2 UI) for DAO, red circle (2 UI) for mentalis.
Figure 5
Figure 5
Patient with platysmal band linked to platysmal synkinesis and hyperkinesis. Black arrows showing subdermal injection of four UIs of botulinum toxin.
Figure 6
Figure 6
Patient with right mouth–eye hyperkinesis and synkinesis, at rest, smiling, and kissing. (A) Before botulinum-toxin injections. (B) One month after botulinum-toxin injections.
Figure 7
Figure 7
Patient’s treatment plan. Black cross is the injection site, and the number next to it is the number of units of botulinum injection.
See this image and copyright information in PMC

References

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