- Email: [email protected]
Prospective analysis of the outcome of botulinum toxin injection in facial myofascial pain
Abstracts / British Journal of Oral and Maxillofacial Surgery 45 (2007) e30–e63
ence to inter-incisal opening, lateral translations and protrusion. A significant increase in mouth opening occurred intraoperatively in 69% of patients. Those who suffered from TMJ crepitus and muscle tenderness were less likely to improve. We will discuss the relationships between the various parameters in detail. doi:10.1016/j.bjoms.2007.07.088 88 The use of Lugol’s Iodine in the resection of oral and oropharyngeal squamous cell carcinoma Jeremy McMahon ∗ , J. Devine, J. McCaul, D. McLellan, G. Bryson South Glasgow University Teaching Hospitals, United Kingdom Background: A number of reports indicate that in the surgical treatment of oral and oropharyngeal cancer, dysplasia at surgical margins is a predictor of local recurrence. This study evaluates the utility of Lugol’s Iodine in achieving margins free of dysplasia, carcinoma-in-situ, and invasive carcinoma. Methods: A consecutive series of 50 patients undergoing surgical resection of oral cavity and oropharyngeal tumours from October 2004–December 2005 comprised the standard group. They underwent removal of mucosal SCC with a macroscopic 1cm margin as well as removal of adjacent macroscopic leukoplakia. The Lugol’s Iodine group comprised a consecutive group of 37 patients undergoing resection of oral and oropharyngeal SCC’s from March to December 2006. These patients underwent removal of primary tumours with a 1 cm macroscopic margin plus any adjacent mucosa unstained after the topical application of Lugol’s Iodine, where this was feasible. Results: Of 50 patients in the standard group a total of 16 (32%) had dysplasia, Ca-in-situ, or invasive SCC at a mucosal surgical margin. Of 37 patients in the Lugol’s Iodine group 1 (2.7%) had dysplasia at a surgical margin. Conclusions: Lugol’s Iodine is a simple, inexpensive, and apparently effective means of reducing the likelihood of unsatisfactory surgical margins in the resection of oral and oropharyngeal squamous cell carcinoma. doi:10.1016/j.bjoms.2007.07.089 89 Prospective analysis of the outcome of botulinum toxin injection in facial myofascial pain Amish Arun Patel ∗ , Andrew J. Sidebottom Nottingham University Hospitals, United Kingdom Myofascial pain is a chronic muscle pain presenting as one of the spectrum of temporomandibular joint pain dysfunction syndromes. Current treatment methods include advice, splint therapy, analgesics and physiotherapy. A minority of patients
e59
remain unresponsive to these treatment modalities. Muscle relaxation and hence relief can be achieved with the use of low dose tricyclic antidepressant medication. Some patients are reluctant to comply with this management, do not respond to therapy or discontinue use due to side-effects. An alternative management with botulinum toxin injection into the affected ` 50 units in up to three areas) masticatory muscle (DysportO has been seen to provide relief in a previous retrospective study. We prospectively recruited 19 patients (January– December 2006). Their visual analogue scores for pain on the affected side and mouth opening were recorded before and 6 weeks following administration of the botulinum toxin injection. Of the 26 sides treated 22 (85%) showed some improvement. Eleven (42%) had more than an 80% reduction in their VAS. Three patients have required more than one course of treatment to the same affected side. The only complication has been one case of zygomaticus muscle weakness, which resolved after 4 months. The administration of botulinum toxin intra-muscular injection improves the outcome of patients with facial myofascial pain in the short term and is hence a useful second-line management option. We will present the longterm outcome of this group along with any further patients recruited. doi:10.1016/j.bjoms.2007.07.090 90 An evaluation of the speech and swallowing in patients treated for oro-pharyngeal squamous cell carcinoma Chaitanya Katre ∗ , S.N. Rogers, T.M. Jones, L. Thomas, D. Lowe Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, United Kingdom Introduction: For tumours arising in the oro-pharyngeal region speech and swallowing problems are arguably the most important functional concerns for the patient’s. Aim: To assess in detail the subjective (patient derived) speech and swallowing outcomes following treatment for oro-pharyngeal carcinoma (soft palate, pharynx, tonsil and base of tongue). Method: The Liverpool head and neck database was searched for patient’s treated between 1 January 1999 and 31 May 2005 for oro-pharyngeal carcinoma. One hundred and ten patients were identified, 77 were willing to participate, 4 were untraceable and 29 unwilling to participate. Patients completed UWQOL questionnaire, two swallowing specific questionnairs (MDADI, SWAL QOL) and two speech specific questionnaires (V-RQOL, VHI). A variety of treatment modalities were used including primary surgery, primary radiotherapy and primary surgery with adjuvant radiotherapy. Results: Patients ranged from 5 years to 2 months posttreatment, median 21 months and ranked swallowing as
ence to inter-incisal opening, lateral translations and protrusion. A significant increase in mouth opening occurred intraoperatively in 69% of patients. Those who suffered from TMJ crepitus and muscle tenderness were less likely to improve. We will discuss the relationships between the various parameters in detail. doi:10.1016/j.bjoms.2007.07.088 88 The use of Lugol’s Iodine in the resection of oral and oropharyngeal squamous cell carcinoma Jeremy McMahon ∗ , J. Devine, J. McCaul, D. McLellan, G. Bryson South Glasgow University Teaching Hospitals, United Kingdom Background: A number of reports indicate that in the surgical treatment of oral and oropharyngeal cancer, dysplasia at surgical margins is a predictor of local recurrence. This study evaluates the utility of Lugol’s Iodine in achieving margins free of dysplasia, carcinoma-in-situ, and invasive carcinoma. Methods: A consecutive series of 50 patients undergoing surgical resection of oral cavity and oropharyngeal tumours from October 2004–December 2005 comprised the standard group. They underwent removal of mucosal SCC with a macroscopic 1cm margin as well as removal of adjacent macroscopic leukoplakia. The Lugol’s Iodine group comprised a consecutive group of 37 patients undergoing resection of oral and oropharyngeal SCC’s from March to December 2006. These patients underwent removal of primary tumours with a 1 cm macroscopic margin plus any adjacent mucosa unstained after the topical application of Lugol’s Iodine, where this was feasible. Results: Of 50 patients in the standard group a total of 16 (32%) had dysplasia, Ca-in-situ, or invasive SCC at a mucosal surgical margin. Of 37 patients in the Lugol’s Iodine group 1 (2.7%) had dysplasia at a surgical margin. Conclusions: Lugol’s Iodine is a simple, inexpensive, and apparently effective means of reducing the likelihood of unsatisfactory surgical margins in the resection of oral and oropharyngeal squamous cell carcinoma. doi:10.1016/j.bjoms.2007.07.089 89 Prospective analysis of the outcome of botulinum toxin injection in facial myofascial pain Amish Arun Patel ∗ , Andrew J. Sidebottom Nottingham University Hospitals, United Kingdom Myofascial pain is a chronic muscle pain presenting as one of the spectrum of temporomandibular joint pain dysfunction syndromes. Current treatment methods include advice, splint therapy, analgesics and physiotherapy. A minority of patients
e59
remain unresponsive to these treatment modalities. Muscle relaxation and hence relief can be achieved with the use of low dose tricyclic antidepressant medication. Some patients are reluctant to comply with this management, do not respond to therapy or discontinue use due to side-effects. An alternative management with botulinum toxin injection into the affected ` 50 units in up to three areas) masticatory muscle (DysportO has been seen to provide relief in a previous retrospective study. We prospectively recruited 19 patients (January– December 2006). Their visual analogue scores for pain on the affected side and mouth opening were recorded before and 6 weeks following administration of the botulinum toxin injection. Of the 26 sides treated 22 (85%) showed some improvement. Eleven (42%) had more than an 80% reduction in their VAS. Three patients have required more than one course of treatment to the same affected side. The only complication has been one case of zygomaticus muscle weakness, which resolved after 4 months. The administration of botulinum toxin intra-muscular injection improves the outcome of patients with facial myofascial pain in the short term and is hence a useful second-line management option. We will present the longterm outcome of this group along with any further patients recruited. doi:10.1016/j.bjoms.2007.07.090 90 An evaluation of the speech and swallowing in patients treated for oro-pharyngeal squamous cell carcinoma Chaitanya Katre ∗ , S.N. Rogers, T.M. Jones, L. Thomas, D. Lowe Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, United Kingdom Introduction: For tumours arising in the oro-pharyngeal region speech and swallowing problems are arguably the most important functional concerns for the patient’s. Aim: To assess in detail the subjective (patient derived) speech and swallowing outcomes following treatment for oro-pharyngeal carcinoma (soft palate, pharynx, tonsil and base of tongue). Method: The Liverpool head and neck database was searched for patient’s treated between 1 January 1999 and 31 May 2005 for oro-pharyngeal carcinoma. One hundred and ten patients were identified, 77 were willing to participate, 4 were untraceable and 29 unwilling to participate. Patients completed UWQOL questionnaire, two swallowing specific questionnairs (MDADI, SWAL QOL) and two speech specific questionnaires (V-RQOL, VHI). A variety of treatment modalities were used including primary surgery, primary radiotherapy and primary surgery with adjuvant radiotherapy. Results: Patients ranged from 5 years to 2 months posttreatment, median 21 months and ranked swallowing as