肉毒杆菌毒素A注射治疗良性咬肌肥大

Botulinum toxin type A for treating benign masseteric hypertrophy

目的:观察肉毒杆菌毒素A注射治疗良性咬肌肥大的临床疗效。方法:于2004-11/2005-12选择南方医科大学南方医院整形科收治的良性咬肌肥大患者15例,30侧咬肌。根据患者咬肌厚度不同注射肉毒杆菌毒素A,咬肌厚度<11mm注射50U/侧,11～13mm注射80U/侧,>13mm注射100U/侧。每侧咬肌分3～5点注射肉毒杆菌毒素A50～100U,分别于注射前及注射后两三个月内行B超检查,测量咬肌厚度及形态变化。结果:纳入患者15例,均进入结果分析。①15例患者注射后咬肌厚度均明显小于注射前,差异有非常显著性意义[咬肌松弛状态下分别为(0.7800±0.1140),(1.0907±0.1621)cm;咬肌收缩状态分别为(0.9643±0.1774),(1.5050±0.1195)cm,P<0.001]。咬肌松弛状态下平均缩小28.6%,咬肌收缩状态下平均缩小35.9%。②患者接受注射治疗一两周后,咬合力量减弱或消失,2～4周后可见咬肌缩小,效果最明显出现在注射后4周～3个月,三四个月后咬肌力量及体积逐渐恢复,6个月后尽管肌力基本恢复正常,但咬肌体积的恢复各不相同。15例患者中对注射后所产生的效果非常满意13例(86.7%),基本满意2例(13.3%)。结论:应用肉毒杆菌毒素A治疗良性咬肌肥大,操作简单,效果可靠,副作用少,是外科手术治疗之外的一个可选择的方法。

AIM： To investigate the clinical therapeutic effect of botulinum toxin type A （BTXA） for benign masseteric hypertrophy. METHODS： Fifteen benign masseteric hypertrophy patients （30 pieces of masseter muscle） were selected from the Department of Plastic Surgery, Nanfang Hospital of Southern Medical University from November 2004 to December 2005. BTXA was applied according to the various thickness of masseter muscle： 50 U BTXA was injected in each masseter for the patients whose masseteric thickness were less than 11 mm, 80 U BTXA for 11-13 mm, and 100 U BTXA for more than 13 ram. The injection of 50- 100 U BTXA was divided into 3-5 points of masseter muscle. The B-mede ultrasonogram was used to measure the thickness and morphology changes of masseter muscle before BTXA injection and within 2-3 months after injection respectively. RESULTS： Totally 15 cases were involved in the result analysis. ①The masseteric thickness of the 15 patients were obviously reduced postinjection than pre-injeetion. And the difference was significant [In state of relaxation, the masseterie thickness： （0.780 0±0.114 0）, （1.090 7±0.162 1） cm; In state of contraction, the masseteric thickness： （0.964 3±0.177 4）, （1.505 0±0.119 5） cm, P 〈 0.001]. Compared with the volume before injection, the average reduction rate of the injected masseter was 28.6% in state of relaxation and 35.9% in state of contraction. ②The strength of occluding was obviously reduced or disappeared 1-2 weeks after BTXA injection. And the volume of the injected masseter was reduced 2-4 weeks after BTXA injection. But the maximum reduction was observed in the period of 4 weeks to 3 months after injection. The strength and volume of masseter was recovered gradually 3-4 months after injection. Although the strength of masseter could recover to normal condition 6 months later in most patients, but the recovery of masseteric volume was different from one to another. There were 13 out of 15 patients satisfying the results （86.7%）, and two eases were satisfied generally （13.3%）. CONCLUSION： Owing to the simple operation, reliable results and few side effects, BTXA treatment for benign masseterie hypertrophy is an alternative method exclude surgery.