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Botulinum toxin in the managment of focal dystonias of the maxillofacial region
029B- Anesthesia~facial pain~facial cosmetic surgery~nerve repair~trauma management~wound repair~miscellaneous 4. Botulinum Toxin in the Managment of Focal Dystonias of the Maxillofacial Region
Fisher, B., Costello, B., Kempers, K., Foote, J. Department of OMS, University of Pennsylvania Hospital, Philadelphia, PA The toxin produced by Clostridium botulinum is a potent paralytic agent. Its effects of inhibiting the release of acetycholine from the nerve terminal at the neuromuscular junction is well documented. Through the past twenty tears, therapeutic uses for this toxin have been described. Of these, local injection into spasmotic or hyperfunctioning muscles has shown great promise. Use of this toxin for injection results in local muscle flaccidity with a variable period of effect. Reinjection appears to serve as adequate therapy without significant risk of disastrous side effects or complications. Thirteen patients with various focal dystonias involving the head and neck region were treated by us with botulinum toxin injections. These included three cases of idiopathic blepharospasm, 2 cases involving lateral pterygoid spasm, one case of intractable mentalis muscle spasm, three cases of spasm of the buccinator, three injections were given for spasm of the temporalis muscle, and one patient was injected for spasm of the trapezius muscle. Doses of toxin injected were titrated based on the number and size of the muscles to be injected. Results were measured both subjectively and objectively. Follow up has ranged from 4 months to 2 years. All of our patients experienced some improvement. One patient did experience a dermatitis in the region of the injection, but this was easily managed with topical steroid based cream. N o other complications were noted. Our conclusion is that botulinum toxin is a safe and effective treatment for focal dystonias of tile head and neck region.
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with ortopantomograms, salivary tests and tests of the oral microflora. Every person answered a questionnaire about her/his general, oral and dental health, regular medication, dental care, health risk factors, etc. According to the study criteria 35% of the studied were referred to Helsinki or Oulu Maxillofacial units for further examination of mucosal lesions. 30% of them had a biopsy performed. All collected and observed data recorded on standardized forms were stored in a data base and analyzed.
Results 31% of this population had a chronic heart disease, 38% high blood pressure, 14% a respiratory disease, 11% diabetes and 6.5% rheumatoid arthritis. 9% suffered from 3 or more of these diseases, 19% from two and 34% from one disease. 45% had smoked, 31% were still smokers. Totally edentulous persons were found in 37%. 56% of persons had no teeth in the upper jaw, practically all of them had dental prostheses. Fungal test (Oricult) was positive in 56%, more frequently in patients with prostheses in the upper jaw (63% versus 44%). In dentate persons dental focuses were frequently observed in panoramic radiological examination. More than 40% had an immediate need for dental care due to periapical abscesses or profound pariodontal disease. In 22.5% of persons more than three serious dental focuses were recorded. Different oral lesions were recorded in 72% of persons. In 12% of the study population a mucosal lesion, which might indicate an elevated risk for oral cancer was observed at primary examination. Conclusions These figures show that the impact of oral health and function on general health of senior citizens in Finland need special attention, especially from the oral and maxillofacial point of view. The increased life expectance of the Finnish population, the frequency of diseases and medication of the senior citizens, make new demands on the dentists and dental clinic staff and raise a need for more oral and maxillofacial surgeons and other dental specialists, well equipped specialist managed clinics and hospital units and a more equal security system in Finland to assure adequate treatment, a better oral, dental and general health and quality of life for our senior citizens.
5. Impact of Oral Mucosal and Dental Health and General Health in Finnish Senior Citizens
Sodevholm, A., Olkarinen, K., Remes-Lyly, T., Haikola, B., Laukkanen, P.
Department of Maxillofacial Surgery, Helsinki University Hospital, HeIsinki, Finland
6. The Four Categories Pertaining To Composite or Multimodalily Facial Rejuvenation Faerber, T..
Overland Park, KS This survey study was performed to evaluate the oral health in Finnish senior citizens.
Study design One third of the population 58 years or older, in two communities, one in northern Finland, the other close to the capital, Helsinki, was examined in 7 different age cohorts, totally 1191 persons (53% women, 47% men). A standardized oral examination was performed by the same dentist in the health care dental clinic of the community, completed
Recent advances in laser resurfacing, rhytidectomy and fat transfer allow the surgeon to provide dramatic facial rejuvenation. Facial skeletal augmentation procedures have been classically combined with other facial rejuvenation procedures. With the advent of improved postoperative wound care simultaneous face lifting and laser resurfacing can be provided. When simultaneous laser resurfacing, face lifting, fat grafting, and skeletal augmentation are completed a true
Fisher, B., Costello, B., Kempers, K., Foote, J. Department of OMS, University of Pennsylvania Hospital, Philadelphia, PA The toxin produced by Clostridium botulinum is a potent paralytic agent. Its effects of inhibiting the release of acetycholine from the nerve terminal at the neuromuscular junction is well documented. Through the past twenty tears, therapeutic uses for this toxin have been described. Of these, local injection into spasmotic or hyperfunctioning muscles has shown great promise. Use of this toxin for injection results in local muscle flaccidity with a variable period of effect. Reinjection appears to serve as adequate therapy without significant risk of disastrous side effects or complications. Thirteen patients with various focal dystonias involving the head and neck region were treated by us with botulinum toxin injections. These included three cases of idiopathic blepharospasm, 2 cases involving lateral pterygoid spasm, one case of intractable mentalis muscle spasm, three cases of spasm of the buccinator, three injections were given for spasm of the temporalis muscle, and one patient was injected for spasm of the trapezius muscle. Doses of toxin injected were titrated based on the number and size of the muscles to be injected. Results were measured both subjectively and objectively. Follow up has ranged from 4 months to 2 years. All of our patients experienced some improvement. One patient did experience a dermatitis in the region of the injection, but this was easily managed with topical steroid based cream. N o other complications were noted. Our conclusion is that botulinum toxin is a safe and effective treatment for focal dystonias of tile head and neck region.
111
with ortopantomograms, salivary tests and tests of the oral microflora. Every person answered a questionnaire about her/his general, oral and dental health, regular medication, dental care, health risk factors, etc. According to the study criteria 35% of the studied were referred to Helsinki or Oulu Maxillofacial units for further examination of mucosal lesions. 30% of them had a biopsy performed. All collected and observed data recorded on standardized forms were stored in a data base and analyzed.
Results 31% of this population had a chronic heart disease, 38% high blood pressure, 14% a respiratory disease, 11% diabetes and 6.5% rheumatoid arthritis. 9% suffered from 3 or more of these diseases, 19% from two and 34% from one disease. 45% had smoked, 31% were still smokers. Totally edentulous persons were found in 37%. 56% of persons had no teeth in the upper jaw, practically all of them had dental prostheses. Fungal test (Oricult) was positive in 56%, more frequently in patients with prostheses in the upper jaw (63% versus 44%). In dentate persons dental focuses were frequently observed in panoramic radiological examination. More than 40% had an immediate need for dental care due to periapical abscesses or profound pariodontal disease. In 22.5% of persons more than three serious dental focuses were recorded. Different oral lesions were recorded in 72% of persons. In 12% of the study population a mucosal lesion, which might indicate an elevated risk for oral cancer was observed at primary examination. Conclusions These figures show that the impact of oral health and function on general health of senior citizens in Finland need special attention, especially from the oral and maxillofacial point of view. The increased life expectance of the Finnish population, the frequency of diseases and medication of the senior citizens, make new demands on the dentists and dental clinic staff and raise a need for more oral and maxillofacial surgeons and other dental specialists, well equipped specialist managed clinics and hospital units and a more equal security system in Finland to assure adequate treatment, a better oral, dental and general health and quality of life for our senior citizens.
5. Impact of Oral Mucosal and Dental Health and General Health in Finnish Senior Citizens
Sodevholm, A., Olkarinen, K., Remes-Lyly, T., Haikola, B., Laukkanen, P.
Department of Maxillofacial Surgery, Helsinki University Hospital, HeIsinki, Finland
6. The Four Categories Pertaining To Composite or Multimodalily Facial Rejuvenation Faerber, T..
Overland Park, KS This survey study was performed to evaluate the oral health in Finnish senior citizens.
Study design One third of the population 58 years or older, in two communities, one in northern Finland, the other close to the capital, Helsinki, was examined in 7 different age cohorts, totally 1191 persons (53% women, 47% men). A standardized oral examination was performed by the same dentist in the health care dental clinic of the community, completed
Recent advances in laser resurfacing, rhytidectomy and fat transfer allow the surgeon to provide dramatic facial rejuvenation. Facial skeletal augmentation procedures have been classically combined with other facial rejuvenation procedures. With the advent of improved postoperative wound care simultaneous face lifting and laser resurfacing can be provided. When simultaneous laser resurfacing, face lifting, fat grafting, and skeletal augmentation are completed a true