[Botulinum toxin in oromaxillofacial surgery]

The muscular system of the jaw and face is characterized by highly differential dynamics due to its strong presence within the motoric region of the cerebral cortex. Abnormal activity of the masticatory or mimic muscular system, whether acquired or congenital, leads to aesthetic and/or functional impairments for the patient. Subsequently, pathological changes of the tissue structure caused by persistent dysfunction can entail chronic pain and progressive aesthetic reduction can induce psychopathological conditions in a patient.

Inherently, surgical techniques for the treatment of muscular imbalances are inadequately differentiated, resulting in the destruction of nerve and muscular structures and are thus irreversible.

Use of botulinum toxin A can achieve short-term correction of muscular activities with very few side effects if applied in an accurate and controlled manner. This survey presents both established treatments as well as newly developed applications in craniomaxillofacial surgery: (1) the treatment of dysfunctions of the masticatory muscular system, (2) the correction of marked imbalances of the mimic muscular system resulting from surgical treatment, (3) the therapy of salivary gland-associated malfunctions, such as hypersalivation or Frey's syndrome, (4) aesthetic corrections with botulinum toxin A as a single therapy or in combination with collagen injections, (5) EMG-controlled injection of botulinum toxin A as an alternative to surgical treatment of recurrent dislocation of the TMJ, (6) prophylaxis to prevent relapse after mandibular advancement by EMG-controlled paralysis of the geniohyoid muscles.