Avaliação do efeito da toxina botulínica no lado são em pacientes com paralisia facial de longa duração / Evaluation of the botulinum toxin effect in the healthy side of patients with long-standing facial paralysis

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

INTRODUCTION: Long-standing facial paralysis presents with functional and aesthetic deficits, which are responsible for psychological disturbances and life quality impairment. Even after modern facial reanimation surgical techniques, the emotional movement and the symmetry of the hemifaces is only partially restablished. Botulinum toxin type A causes reversible flacid muscle paralysis, thus correcting imbalances among hypoactive agonists and relatively hyperactive antagonists. There are no standardized series in the literature with more than 10 facial paralysis patients treated with botulinum toxin injection in the non-paralysed side in the mouth area, with the objective of obtaining better dynamic facial symmetry. METHODS: This prospective study had the objective of evaluate, with 6 months follow-up, the effects of the adjuvant treatment using botulinum toxin in the healthy hemiface of 25 patients with long-standing facial paralysis, previously treated surgically. The methods of evaluation were a standardized clinical scale, the patients degree of satisfaction, the Physical Function and Social/well-being Function subscales of the Facial Disability Index and surface electromyography. Total botulinum toxin dose varied from 15 to 69 U, mean 37,9 ± 5,4 U. Sixteen patients presented adverse effects with mean duration time 14,1 ± 7,3 days, including difficulty in speaking, drinking, eating and adapting to the reduced smile. RESULTS: 1) There was significant reduction of facial asymmetry, of 48,4% at 1 month and of 16,8% at 6 months post-treatment. The better symmetry 1 month post-treatment was consequent to reduced movement on the non-paralysed side combined to better evaluation on the paralysed side. At 6 months, the non-paralysed side had similar grading than that of pre-treatment, showing absence of clinical effect of the toxin. At this time, the asymmetry reduction was due to significant increase in the evaluation of the paralysed side in relation to the pre-treatment. 2) Patients satisfaction with facial symmetry showed significant increase, 1 month and 6 months post-treatment. 3) The Physical Function Index increased, but not significantly. The Social/well-being Function Index showed significant increase at 6 months compared to pre-treatment. 4) There was significant decrease in the action potential of the non-paralysed side one month post-injection of the botulinum toxin. After 6 months, the value returned to baseline. CONCLUSIONS: The proposed treatment allowed, with minimally invasive technique, better facial symmetry at rest, evidenced by better mouth, nose and brow position, and on facial movement as a whole, especially when smiling, speaking or exposing teeth. Even after the loss of the clinical effect of the drug at 6 months, there was an 18% increase in the clinical evaluation of the paralysed side in relation to pre-treatment, and increase in the satisfaction and quality of life indexes.

ASSUNTO(S)

quality of life toxina botulínica tipo a assimetria facial/terapia facial paralysis qualidade de vida botulinum toxin type a eletromiografia facial asymmetry/therapy electromyography paralisia facial

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