Small bruises may appear but rarely.
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In the following week, it is possible to feel tugging of the forehead or feeling tension. Mobility is decreased but not fixed if the doses are light. Some transient headache-type reactions have been described. Poorly injected by an untrained practitioner, botulinum toxin can then temporarily paralyze unwanted muscles in the face drooping eyelid, embarrassment to smile, eyebrows too high or too low ….
Would you like to call on a practitioner who is competent? Click on the bottom of the page, you will be able to get in touch with a doctor belonging to our association the AFME. You will have the certainty with an expert who has received specific training. After 4 to 6 days, the effects of the toxin are visible: spontaneous smoothing of the upper half of the face. The forehead is smooth, loses its stern and sad character. At first, the effect of the injections decreases gradually after 4 months.
By renewing the session without waiting too long, it is usual to obtain after 3 sessions results lasting 6 to 7 months or longer. There is no paralysis or muscular destruction that sets in but, quite often, we lose the habit of frowning in these areas. Home Botox. Injection of botulinum toxin against wrinkles. In this article, we will tell you more about botox injection, the principle of this aesthetic method, its price, contraindications, the duration of treatment, … After reading our article you will find at the bottom of the page a button that will allow you to access our tool linking patients and doctors.
The botulinum toxin does not tend, it relaxes the skin. The product: Botulinum endotoxin. The technique of botulinum toxin injections. The aims of this point of view are to discuss indications, contraindications, technical aspects and the efficacy of botox treatment in combination with fissurectomy for chronic anal fissures.
Botulinum toxin type A is produced by Clostridium botulinum and is known to be one of the most lethal neurotoxins. Clostridium botulinum grows in inadequately sterilized canned foods.
Risks of botox
Its toxin blocks synaptic release of acetylcholine and causes a severe paralysis of respiratory and skeletal muscles botulism. Botox became popular in cosmetic surgery for treatment of crinkles in the face. Medical uses for the toxin are blepharospasm, strabismus, spasmodic torticollis, spastic cerebral palsy. Traditionally, an anal fissure was thought to be due to constipation and passage of hard stool.
Today, an increased tonicity of the internal sphincter is blamed for anal fissures. Tonic contraction of the internal anal sphincter is mediated by sympathetic innervations, which stays in state of partial contraction and relaxation in response to rectal distension. The combined concept of sphincter spasm and reduced anodermal blood flow not only explains how surgical disruption of the internal anal sphincter allows the fissure to heal anal pressures decreases with a rise of anal blood flowbut also gives the explanation on how botox works as treatment of anal fissures: botox relaxes the internal anal sphincter when injected into the muscle by causing temporary synaptic blockade and reversible denervation.
This leads to a decrease of the anal pressure allowing the fissure to heal. The effect of botox is similar to surgical sphincterotomy without the disadvantage of an anatomical disruption of the internal anal sphincter. However, it should be mentioned that the concept of sphincter spasm and reduced anal blood flow does not answer the question, whether sphincter spasm is the cause or effect of anal fissures.
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Maria et al. Botox reduces the anal resting pressure, an effect that persists for two to three months. But note that, the use of botox is not without risk. But the main shortcomings of this analysis were the short follow-up of two months in one and the not reported recurrence rate in two of the included studies. The authors concluded that botox could be recommended as first-line treatment in patients with chronic anal fissures.
However, they also stated that stronger evidence is needed to definitively support this treatment strategy because only three trials done on patients were qualified for the meta-analysis. However, there was no consensus on dosage, precise site of administration internal anal sphincter, external anal sphincter, or intersphincteric space and number of injections. For refractory anal fissures, surgery is still the treatment of choice.
However, there is a considerable risk for incontinence. Incontinence after a lateral internal sphincterotomy: are we underestimating it? The concept of fissurectomy, in combination with reversible chemical sphincterotomy or botoxwas first introduced by Engel et al. The fissurectomy, as wound debridement, supports wound healing and botox injection Figure 2decreases the tonus of the internal anal sphincter temporary leading to an increased anal blood flow.
These results were in accordance with Lindsey et al. Sileri et al. Incontinence for flatus was described in 4.
Surgical excision of fissure edges and sentinel skin tag. Triangle shape of excision facilitates wound drainage. Résection chirurgicale des berges de la fissure avec sa marisque sentinelle.
The significance of botox in the treatment of chronic anal fissures is still puzzling. Data in the literature are inconsistent and final conclusions cannot be drawn. From our point of view, botox will not replace surgical treatment for refractory anal fissures. Fissurectomy and botox injection, however, treats both main causes of chronicity of anal fissures, the presence of bradytrophic scar tissue and the high resting anal pressure.
This combined treatment strategy is very promising for the treatment of chronic anal fissures with a high success rate and a low morbidity and most importantly with very little risk of incontinence. Français Español Italiano.