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Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin

Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
The binding of dantrolene to the RYR1...

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...

Depolarizing Blockers: Pharmocokinetics

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...

Depolarizing Blockers: Mechanism of Action

Depolarizing Blockers: Mechanism of Action

Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because...

Muscles for Facial Expressions

Muscles for Facial Expressions

The craniofacial muscles are a collection of approximately 20 thin skeletal muscles situated beneath the skin of the face and scalp. These muscles, primarily responsible for the vast array of human facial expressions, originate from the bones or fibrous structures of the skull and extend outwards to connect with the skin. While most skeletal muscles in the body are enveloped in thick fascia, facial muscles generally have a more delicate fascial covering, with the buccinator muscle being a...

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Related Experiment Video

Updated: Dec 12, 2025

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

Published on: March 1, 2015

Botulinum Toxin for Paramedian Interpolated Forehead Flaps.

Matthew J Lin¹, Danielle P Dubin¹, Hooman Khorasani¹

¹Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Journal of Cutaneous and Aesthetic Surgery

|August 15, 2020

Summary

Injecting botulinum toxin during wound closure improves scar outcomes for patients receiving paramedian forehead flaps. This method reduces wound tension by temporarily paralyzing facial muscles, leading to better cosmetic results.

Keywords:

Botulinum toxin Mohs micrographic surgery interpolated flap neuromodulators paramedian forehead flap reconstructive surgery scar

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Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction

Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction

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Last Updated: Dec 12, 2025

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

Published on: March 1, 2015

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea

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Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction

Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction

Published on: December 5, 2025

Area of Science:

Plastic Surgery
Dermatology
Wound Healing

Background:

Forehead skin matches midface, making paramedian forehead flaps ideal for midface defect repair.
Donor site scarring on the forehead is a significant cosmetic concern.
Minimizing scarring is a key goal in reconstructive surgery.

Purpose of the Study:

To evaluate the efficacy of botulinum toxin in improving scar outcomes after paramedian forehead flap reconstruction.
To explore the potential mechanisms behind botulinum toxin's effect on scar healing.

Main Methods:

Addition of 50 units of botulinum toxin at the time of wound closure.
Reconstruction using paramedian interpolated flaps.
Assessment of scar outcomes post-procedure.

Main Results:

Improved scar outcomes observed in patients treated with botulinum toxin.
Botulinum toxin application led to reduced wound tension.
Facial muscle immobilization is a likely factor in enhanced healing.

Conclusions:

Botulinum toxin is a valuable adjunct for minimizing scarring in paramedian forehead flap donor sites.
The mechanism involves reducing tension through temporary muscle paralysis.
This technique offers enhanced cosmetic results for patients undergoing facial reconstruction.