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Andrew Blitzer, MD, DDS; Mitchell F. Brin, MD; Monte S. Keen, MD; Jonathan E. Aviv, MD

Arch Otolaryngol Head Neck Surg. 1993;119(9):1018-1022.

Abstract
Objective
To determine the effectiveness of botulinum toxin injections for the management of hyperfunctional facial lines in patients with dystonia.

Design
Twenty-six patients were included in the study: 24 patients had dystonic movement of the face as either a primary or secondary component, and two patients were treated for purely hyperfunctional lines. Botulinum toxin type A was injected via a monopolar hollow-bore Tefloncoated electromyography needle into the facial muscles associated with the hyperfunctional lines. Doses were divided into 1.25- to 10-U aliquots. Qualitative assessments by the patient and physician were made before injection and 2 to 3 weeks after injection.

Patients
Twenty-six patients (two male and 24 female) with hyperfunctional lines were included. The ages were from 32 to 84 years with an average age of 59 years. Twenty had dystonia, four had hemifacial spasm, and two had pure hyperfunction without neuromuscular disease.

Results
All of the patients had an effect of toxin within the first 24 to 72 hours. All of the patients experienced benefit from the toxin injections with partial or total resolution of painful contractions or unsightly hyperfunctional lines and spasms. The effects of the injection lasted 3 to 6 months. No systemic side effects were noted. Adverse effects included mild, temporary eyelid or lip weakness.

Conclusion
Based on this initial pilot study, botulinum toxin may be an important new option for the treatment of patients with hyperfunctional facial lines.

(Arch Otolaryngol Head Neck Surg. 1993;119:1018-1022)

Author Affiliations
From the Departments of Otolaryngology (Drs Blitzer, Keen, and Aviv) and Neurology (Dr Brin) and the Dystonia Clinical Research Center, Columbia-Presbyterian Medical Center, New York, NY.

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