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Uso da toxina botulínica no tratamento da paralisia facial periférica: revisão narrativa
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Abstract(s)
A Paralisia Facial Periférica, também conhecida como paralisia de Bell, é uma doença neurológica geralmente benigna e transitória, de origem desconhecida, que afeta o nervo facial responsável pelos movimentos dos músculos da expressão facial, provocando uma paralisia facial unilateral. Esta patologia pode ser precipitada por eventos que interferem com o sistema imunológico como o stresse, a exposição ao sol ou ao frio e a infeção com vírus Herpes simplex. A paralisia de Bell causa uma série de sintomas que afetam a capacidade de movimentação unilateral da face do paciente. Estes sintomas podem incluir a inclinação da boca em direção ao lado saudável, dificuldade em fechar completamente o olho e levantar a sobrancelha e a diminuição ou até mesmo a ausência de rugas da testa, levando a uma assimetria facial significativa. Qualquer movimento que envolva a expressão facial, como sorrir ou falar, pode ficar comprometido. Além da parte funcional ser gravemente afetada, a parte estética também acaba por provocar um grande desconforto e constrangimento, levando muitas vezes a uma limitação das interações sociais e afetando negativamente a saúde mental e o bem-estar desses pacientes. A toxina botulínica tipo A tem sido usada como tratamento coadjuvante para esta patologia, através de injeções intramusculares em certos músculos da expressão facial do lado não comprometido, diminuindo a diferença da tonicidade dos músculos do lado paralisado para o lado saudável, promovendo uma melhoria da simetria, tanto em repouso como em movimento. Considerando que a etiologia e a patogénese da paralisia de Bell são incertas, o seu tratamento continua a ser objeto de investigação e estudo.
Objetivo: Avaliar o potencial da toxina botulínica na melhoria da assimetria facial no tratamento coadjuvante da Paralisia de Bell, com ênfase na dosagem farmacológica utilizada e musculatura envolvida, através de uma revisão narrativa da literatura.
Metodologia: Pesquisa nas bases de dados: Pubmed, Science Direct e no motor de busca Google Scholar com as seguintes palavras-chave: (botulinum toxin) AND (Bell's palsy) abrangendo diversas fontes de informação, como artigos de revisão, diretrizes clínicas (Guidelines) e estudos observacionais e de coorte "in vivo" publicados nos últimos cinco anos, em inglês e português.
Conclusão: A partir da pesquisa realizada, foi constatado que não existe um guia definitivo para o uso da toxina botulínica no contexto da Paralisia de Bell. Pelos artigos selecionados, conclui-se que a dosagem estética padrão pode não ser ideal para o tratamento da Paralisia de Bell devido à complexidade das alterações neuromusculares envolvidas; é indicado o início do tratamento com o uso de doses mínimas de toxina botulínica e realização de possíveis ajustes após 15 dias. O grau da paralisia muscular pode variar entre os pacientes, o que força a necessidade de uma abordagem individualizada e baseada em evidências na prática clínica.
Peripheral Facial Paralysis, also known as Bell's palsy, is a generally benign and transient neurological disease of unknown origin that affects the facial nerve, responsible for the movements of the muscles of facial expression, causing unilateral facial paralysis. This pathology can be precipitated by events that interfere with the immune system, such as stress, exposure to the sun or cold and infection with the Herpes simplex virus. Bell's Palsy causes a series of symptoms that affect the patient's ability to move one side of the face. These symptoms may include the mouth tilting towards the healthy side, difficulty in completely closing the eye and raising the eyebrow, and the decrease or even absence of forehead wrinkles, leading to significant facial asymmetry. Any movement involving facial expression, such as smiling or speaking, can be compromised. In addition to the functional part being severely affected, the aesthetic part also ends up generating great discomfort and embarrassment, often leading to limitation of social interactions and negatively affecting the mental health and well-being of these patients. Botulinum toxin type A has been used as an adjuvant treatment for this pathology, through intramuscular injections in certain muscles of facial expression on the uncompromised side, decreasing the difference in tonicity of the muscles from the paralyzed side to the healthy side, thus promoting better symmetry, both at rest and in movement. Considering that the etiology and pathogenesis of Bell's Palsy are still uncertain, the treatment of this pathology continues to be the subject of investigation and study. Objective: To evaluate the potential of botulinum toxin in improving facial asymmetry in the adjuvant treatment of Bell's Palsy, with emphasis on the pharmacological dosage used and the muscles involved, through a narrative review of the literature. Methodology: Search in databases: Pubmed, Science Direct and the Google Scholar search engine with the following keywords: (botulinum toxin) AND (Bell's palsy) covering various sources of information, such as review articles, clinical guidelines (Guidelines) and observational and "in vivo" cohort studies published in the last five years, in english and portuguese. Conclusion: From the research carried out, it was found that there is no definitive guide for the use of botulinum toxin in the context of Bell's Palsy. From the selected articles it is concluded that the standard aesthetic dosage may not be ideal for the treatment of Bell's Palsy due to the complexity of the neuromuscular changes involved; It is recommended to begin treatment with the use of minimum doses of botulinum toxin and make possible adjustments after 15 days. The degree of muscle paralysis can vary between patients, which forces the need for an individualized and evidence-based approach in clinical practice.
Peripheral Facial Paralysis, also known as Bell's palsy, is a generally benign and transient neurological disease of unknown origin that affects the facial nerve, responsible for the movements of the muscles of facial expression, causing unilateral facial paralysis. This pathology can be precipitated by events that interfere with the immune system, such as stress, exposure to the sun or cold and infection with the Herpes simplex virus. Bell's Palsy causes a series of symptoms that affect the patient's ability to move one side of the face. These symptoms may include the mouth tilting towards the healthy side, difficulty in completely closing the eye and raising the eyebrow, and the decrease or even absence of forehead wrinkles, leading to significant facial asymmetry. Any movement involving facial expression, such as smiling or speaking, can be compromised. In addition to the functional part being severely affected, the aesthetic part also ends up generating great discomfort and embarrassment, often leading to limitation of social interactions and negatively affecting the mental health and well-being of these patients. Botulinum toxin type A has been used as an adjuvant treatment for this pathology, through intramuscular injections in certain muscles of facial expression on the uncompromised side, decreasing the difference in tonicity of the muscles from the paralyzed side to the healthy side, thus promoting better symmetry, both at rest and in movement. Considering that the etiology and pathogenesis of Bell's Palsy are still uncertain, the treatment of this pathology continues to be the subject of investigation and study. Objective: To evaluate the potential of botulinum toxin in improving facial asymmetry in the adjuvant treatment of Bell's Palsy, with emphasis on the pharmacological dosage used and the muscles involved, through a narrative review of the literature. Methodology: Search in databases: Pubmed, Science Direct and the Google Scholar search engine with the following keywords: (botulinum toxin) AND (Bell's palsy) covering various sources of information, such as review articles, clinical guidelines (Guidelines) and observational and "in vivo" cohort studies published in the last five years, in english and portuguese. Conclusion: From the research carried out, it was found that there is no definitive guide for the use of botulinum toxin in the context of Bell's Palsy. From the selected articles it is concluded that the standard aesthetic dosage may not be ideal for the treatment of Bell's Palsy due to the complexity of the neuromuscular changes involved; It is recommended to begin treatment with the use of minimum doses of botulinum toxin and make possible adjustments after 15 days. The degree of muscle paralysis can vary between patients, which forces the need for an individualized and evidence-based approach in clinical practice.
Description
Keywords
Paralisia de Bell Paralisia facial Toxina botulínica Bell's palsy Botulinum toxin Facial palsy