Botulinum Toxin in the Management of Hyperhidrosis and Other Salivary Conditions
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USE OF BOTULINUM TOXIN IN OTORHINOLARYNGOLOGY (A D’SOUZA AND CL NG, SECTION EDITORS)
Botulinum Toxin in the Management of Hyperhidrosis and Other Salivary Conditions Angelos Mantelakis 1
&
Harry Spencer 2 & Jean-Luc Duval 3 & Anil Joshi 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The aim of this review is to summarise the most up-to-date literature on the application of botulinum toxin in hyperhidrosis and other salivary conditions, including sialorrhea, salivary leak and Frey’s syndrome. Surgeons performing this procedure should stay updated with the most recent evidence of its effectiveness for appropriate treatment planning and patient consultation. Recent Findings The use of botulinum toxin in hyperhidrosis provides symptom relief in most patients, with satisfaction rates of 80–100% in the majority of patients. Accidental infiltration of local musculature is the most common complication, providing a transient paralysis which is reversible. There has been an increasing body of evidence on the effectiveness of botulinum toxin in salivary gland conditions. This has been able to confirm and quantify its utility as a temporary symptom relief treatment, with minimal complications. For both conditions examined, there is a lack of literature comparing the effect of botulinum toxin to other treatment modalities. Summary Botulinum toxin has a growing body of evidence in hyperhidrosis and other salivary conditions. Overall, it is a very safe treatment which provides symptom relief and increased patient satisfaction in most patients. During consultations, surgeons should highlight the need of recurrent applications and the risk of diminishing efficacy with continuous use. Keywords Botulinum toxin . Hyperhidrosis . Salivary leak . Sialorrhea . Salivary fistula . Frey’s syndrome
Introduction
This article is part of the Topical collection on Use of Botulinum Toxin in Otorhinolaryngology * Angelos Mantelakis [email protected] Harry Spencer [email protected] Jean-Luc Duval [email protected] Anil Joshi [email protected] 1
Lewisham and Greenwich NHS Trust, Lewisham High Street, London SE 13 6LH, UK
2
St Georges Hospital, London Borough of Wandsworth, UK
3
Addenbrookes Hospital, Cambridge, UK
Botulinum neurotoxins (BoNTs) are a group of seven distinct protein neurotoxins (serotypes A–G) produced by different strains of the anaerobic bacterium Clostridium botulinum [1–3]. Amongst the several subtypes, BoNT-A is the most potent subtype with its first medical use described in 1980 in the treatment of strabismus [4]. Since then, the therapeutic uses of these neurotoxins have increased to include a wide range of medical and surgical conditions. All subtypes of botulinum neurotoxins act by preventing the release of acetylcholine (Ach) at the presynaptic neuromuscular (NM) junction [1–4]. After injection, the toxins bind selectively to the presynaptic surface of cholinergic neurons and are taken up into the cell by endocytosis. There, BoNTs inter
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