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Botulinum toxin A treatment in facial palsy synkinesis : a systematic review and meta-analysis

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Abstract
Background Synkinesis is defined as involuntary movements accompanying by voluntary movements and can occur during the aftermath of peripheral facial palsy, causing functional, aesthetic and psychological problems in the patient. Botulinum toxin A (BTX-A) is frequently used as a safe and effective treatment; however, there is no standardized guideline for the use of BTX-A in synkinesis. The purpose of this article is to review and summarize studies about the BTX-A treatment of synkinesis in patients with a history of peripheral facial palsy; including given dosages, injection sites and time intervals between injections. Materials and methods A multi-database systematic literature search was performed in October 2020 using the following databases: Pubmed, Embase, Medline, and The Cochrane Library. Two authors rated the methodological quality of the included studies independently using the 'Newcastle-Ottawa Quality Assessment Scale' for non-randomised studies' (NOS). Results Four-thousand-five-hundred-and-nineteen articles were found of which 34 studies met the inclusion criteria, in total comprising 1314 patients. Most studies were assessed to be of 'fair' to 'good' methodological quality. The Cohen's kappa (between author FJ and AS) was 0.78. Thirty-one studies investigated the reported dosage injected, 17 studies reported injection location and 17 studies investigated time intervals. A meta-analysis was performed for three studies comprising 106 patients, on the effects of BTX-A treatment on the Synkinesis Assessment Questionnaire (SAQ) scores. The mean difference was 11.599 (range 9.422-13.766), p < 0.01. However, due to inconsistent reporting of data of the included studies, no relationship with the dosage and location could be assessed. Conclusions Many treatment strategies for synkinesis exist, consisting of varying BTX-A brands, dosages, time intervals and different injection locations. Moreover, the individual complaints are very specific, which complicates creating a standardized chemodenervation treatment protocol. The BTX-A treatment of long-term synkinesis is very individual and further studies should focus on a patient-tailored treatment instead of trying to standardize treatment.
Keywords
LONG-TERM, HEMIFACIAL SPASM, INJECTIONS, MANAGEMENT, PARALYSIS, SEQUELAE, COMBINATION, BUCCINATOR, ANTIBODIES, RESISTANCE, Facial palsy, Synkinesis, Botulinum toxin A, Botulinum toxin a, treatment, Ptosis, Otorhinolaryngology, Plastic surgery

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MLA
de Jongh, Frank W., et al. “Botulinum Toxin A Treatment in Facial Palsy Synkinesis : A Systematic Review and Meta-Analysis.” EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, vol. 280, Springer, 2023, pp. 1581–92, doi:10.1007/s00405-022-07796-8.
APA
de Jongh, F. W., Schaeffers, A. W. M. A., Kooreman, Z. E., Ingels, K. J. A. O., van Heerbeek, N., Beurskens, C., … Pouwels, S. (2023). Botulinum toxin A treatment in facial palsy synkinesis : a systematic review and meta-analysis. EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, 280, 1581–1592. https://doi.org/10.1007/s00405-022-07796-8
Chicago author-date
Jongh, Frank W. de, Anouk W. M. A. Schaeffers, Zoe E. Kooreman, Koen J. A. O. Ingels, Niels van Heerbeek, Carien Beurskens, Stan Monstrey, and Sjaak Pouwels. 2023. “Botulinum Toxin A Treatment in Facial Palsy Synkinesis : A Systematic Review and Meta-Analysis.” EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY 280: 1581–92. https://doi.org/10.1007/s00405-022-07796-8.
Chicago author-date (all authors)
de Jongh, Frank W., Anouk W. M. A. Schaeffers, Zoe E. Kooreman, Koen J. A. O. Ingels, Niels van Heerbeek, Carien Beurskens, Stan Monstrey, and Sjaak Pouwels. 2023. “Botulinum Toxin A Treatment in Facial Palsy Synkinesis : A Systematic Review and Meta-Analysis.” EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY 280: 1581–1592. doi:10.1007/s00405-022-07796-8.
Vancouver
1.
de Jongh FW, Schaeffers AWMA, Kooreman ZE, Ingels KJAO, van Heerbeek N, Beurskens C, et al. Botulinum toxin A treatment in facial palsy synkinesis : a systematic review and meta-analysis. EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY. 2023;280:1581–92.
IEEE
[1]
F. W. de Jongh et al., “Botulinum toxin A treatment in facial palsy synkinesis : a systematic review and meta-analysis,” EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, vol. 280, pp. 1581–1592, 2023.
@article{01GRBSBBKMKD5J75J79GP8CTG5,
  abstract     = {{Background Synkinesis is defined as involuntary movements accompanying by voluntary movements and can occur during the aftermath of peripheral facial palsy, causing functional, aesthetic and psychological problems in the patient. Botulinum toxin A (BTX-A) is frequently used as a safe and effective treatment; however, there is no standardized guideline for the use of BTX-A in synkinesis. The purpose of this article is to review and summarize studies about the BTX-A treatment of synkinesis in patients with a history of peripheral facial palsy; including given dosages, injection sites and time intervals between injections. Materials and methods A multi-database systematic literature search was performed in October 2020 using the following databases: Pubmed, Embase, Medline, and The Cochrane Library. Two authors rated the methodological quality of the included studies independently using the 'Newcastle-Ottawa Quality Assessment Scale' for non-randomised studies' (NOS). Results Four-thousand-five-hundred-and-nineteen articles were found of which 34 studies met the inclusion criteria, in total comprising 1314 patients. Most studies were assessed to be of 'fair' to 'good' methodological quality. The Cohen's kappa (between author FJ and AS) was 0.78. Thirty-one studies investigated the reported dosage injected, 17 studies reported injection location and 17 studies investigated time intervals. A meta-analysis was performed for three studies comprising 106 patients, on the effects of BTX-A treatment on the Synkinesis Assessment Questionnaire (SAQ) scores. The mean difference was 11.599 (range 9.422-13.766), p < 0.01. However, due to inconsistent reporting of data of the included studies, no relationship with the dosage and location could be assessed. Conclusions Many treatment strategies for synkinesis exist, consisting of varying BTX-A brands, dosages, time intervals and different injection locations. Moreover, the individual complaints are very specific, which complicates creating a standardized chemodenervation treatment protocol. The BTX-A treatment of long-term synkinesis is very individual and further studies should focus on a patient-tailored treatment instead of trying to standardize treatment.}},
  author       = {{de Jongh, Frank W. and  Schaeffers, Anouk W. M. A. and  Kooreman, Zoe E. and  Ingels, Koen J. A. O. and  van Heerbeek, Niels and  Beurskens, Carien and Monstrey, Stan and Pouwels, Sjaak}},
  issn         = {{0937-4477}},
  journal      = {{EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY}},
  keywords     = {{LONG-TERM,HEMIFACIAL SPASM,INJECTIONS,MANAGEMENT,PARALYSIS,SEQUELAE,COMBINATION,BUCCINATOR,ANTIBODIES,RESISTANCE,Facial palsy,Synkinesis,Botulinum toxin A,Botulinum toxin a,treatment,Ptosis,Otorhinolaryngology,Plastic surgery}},
  language     = {{eng}},
  pages        = {{1581--1592}},
  publisher    = {{Springer}},
  title        = {{Botulinum toxin A treatment in facial palsy synkinesis : a systematic review and meta-analysis}},
  url          = {{http://doi.org/10.1007/s00405-022-07796-8}},
  volume       = {{280}},
  year         = {{2023}},
}

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