A 型肉毒毒素对咀嚼肌的组织学和功能影响的系统回顾:牙颌面矫形和正颌外科手术中的考虑因素。

IF 2 3区 医学 Q2 ANATOMY & MORPHOLOGY Annals of Anatomy-Anatomischer Anzeiger Pub Date : 2024-07-20 DOI:10.1016/j.aanat.2024.152302
Jean-François Guignardat , Gwénaël Raoul , Joël Ferri , James J. Sciote , Romain Nicot
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引用次数: 0

摘要

简介A 型肉毒杆菌毒素可导致肌肉麻痹,被广泛用于咀嚼肌治疗颞下颌关节紊乱、磨牙症或咀嚼肌肥大等口腔疾病。然而,它对肌肉的作用仍不明确。更好地了解这种药物有助于改进其使用,或许还能增加新的适应症,尤其是在牙颌面矫形和正颌外科方面:本系统综述探讨了肉毒毒素对动物和人类咀嚼肌的组织学和功能影响,并根据《系统综述和荟萃分析首选报告项目》声明的建议进行。研究人员在 MEDLINE、Web of Science 和 Cochrane Library 电子数据库中检索了相关文章。纳入标准为肉毒毒素注射后的人类或动物咀嚼肌分析,以及通过光学或电子显微镜进行的组织结构/超微结构分析,或通过咬合力评估(咬合力分析仪)和肌肉活动(肌电图)进行的功能效果分析:在最初的 1578 篇文章中,最终纳入了 44 项研究。在咀嚼肌注射肉毒杆菌会改变其组织学结构和功能特性。人类和动物研究显示,注射一次肉毒杆菌毒素后,咀嚼肌的超微结构会发生变化、萎缩和纤维类型改变。肉毒杆菌毒素降低了咬合力和肌肉活动,但恢复情况并不确定:结论:施加在骨骼上的肌肉力量是面部生长的一个关键特征。咀嚼肌麻痹会改变骨骼上的机械应力,从而重新平衡施加在面部骨骼上的力量。这种新的平衡可能有利于牙齿畸形或手术复发。因此,肉毒杆菌毒素可限制此类患者咀嚼肌的正颌效应。鉴于恢复的不确定性,应避免多次注射,使用方法也不应偏离既定的共识。
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Systematic review of the histological and functional effects of botulinum toxin A on masticatory muscles: Consideration in dentofacial orthopedics and orthognathic surgery

Introduction

Botulinum toxin type A causes muscle paralysis and is widely used in the masticatory muscle for stomatognathic diseases, such as temporomandibular disorder, bruxism, or masseteric hypertrophy. Nonetheless, its muscular effect remains unclear. Better understanding could aid improved use and perhaps new indications, particularly in dentofacial orthopaedics and orthognathic surgery.

Methods

This systematic review explored the histologic and functional effects of botulinum toxin in animal and human masticatory muscles and was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The MEDLINE, Web of Science, and Cochrane Library electronic databases were searched for relevant articles. The inclusion criteria were human or animal masticatory muscle analysis after botulinum toxin injection(s) AND histological structural/ultrastructural analysis by optical or electronic microscopy OR functional effect analysis by bite force evaluation (occlusal force analyzer) and muscle activity (electromyography).

Results

Of an initial 1578 articles, 44 studies were eventually included. Botulinum toxin injection in the masticatory muscle altered its histological structure and functional properties. The human and animal studies revealed ultrastructural change, atrophy, and fiber type modifications of the masticatory muscles after one injection. Botulinum toxin decreased bite force and muscle activity, but recovery was uncertain.

Conclusions

Muscle forces applied on the skeleton is a key feature of facial growth. Masticatory muscle paralysis changes mechanical stress on bones, which rebalances the force applied on facial bones. This new balance could benefit dental deformity or surgical relapse. Therefore, botulinum toxin could limit the orthognathic effect of the masticatory muscles in such patients. Given the uncertain recovery, multiple injections should be avoided, and usage should not deviate from established consensus.

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来源期刊
Annals of Anatomy-Anatomischer Anzeiger
Annals of Anatomy-Anatomischer Anzeiger 医学-解剖学与形态学
CiteScore
4.40
自引率
22.70%
发文量
137
审稿时长
33 days
期刊介绍: Annals of Anatomy publish peer reviewed original articles as well as brief review articles. The journal is open to original papers covering a link between anatomy and areas such as •molecular biology, •cell biology •reproductive biology •immunobiology •developmental biology, neurobiology •embryology as well as •neuroanatomy •neuroimmunology •clinical anatomy •comparative anatomy •modern imaging techniques •evolution, and especially also •aging
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