Botulinum toxin injections, often called Botox injections, are commonly being used these days as a part of a cosmetic makeover. However, its use is not limited to that, and it is in fact extremely useful in managing a number of clinical conditions that involve muscle spasticity.
Botox is a toxin that is produced by the bacterium Clostridium botulinum. The injection form used in treatments is the sterile lyophilised form of botulinum toxin type A. There a variety of formulations available on the market these days, and most of them are used for the same purposes. In a nutshell, they are useful to get rid of wrinkles on the face (cosmetic purposes), in managing spasticity associated with cerebral palsy, spastic paraparesis, blepharospasm and also for the management of pain.
Botulinum toxin is delivered as an injection to the relevant muscle groups, and in this article we will look at the injection techniques in a bit more detail.
The Technique of Botox injection administration
The general technique for injecting Botox consists of using a 1.0 mL Tuberculin type syringe along with needles of varying size depending on the muscle being injected. For superficial injections into the skin and the muscles around the eye, a short 25 gauge to 30 gauge needle may be used. However, for larger muscles, a longer 25 gauge may be used.
Prior to performing the procedure, it is essential to identify the right muscle or muscle groups that require injecting. A thorough clinical examination is warranted, and once this is concluded electromyography studies may be conducted to identify the muscles clearly. Once this has been done, a motor point should be identified on the surface of the muscle. This is the point that is injected with Botox. The skin is cleaned with alcohol and the alcohol allowed to evaporate. The toxin is then injected into the muscle, taking care not to inject it intravascularly.
The time duration taken to inject the toxin depends on the operator experience and the number of muscles that need injecting. Following the procedure, patients may feel a mild amount of pain and discomfort, and this is easily treated with simple analgesics.
Let's take a look at a couple of clinical conditions that require Botox injections.
1. Cerebral palsy
Target muscles that are spastic in children with cerebral palsy (CP) need to be identified using gait analysis. While passive movement of the muscles and joints can help identify muscle groups that need injecting, some groups advocate using ultrasound with or without electromyography to ensure accuracy. Following the injection, the appropriate post injection care such as physical therapy and orthotic management should be considered.
2. Blepharospasm
Here, Botox is diluted with normal saline and is injected using a 30 gauge needle into the orbicularis oculi muscle carefully at around 4 to 5 points around the eye. Care should be taken to ensure ptosis does not occur during injection.
There are many more conditions and a detailed discussion on each of these is out of scope of this article.
Botox injections are common practice in managing muscle spasticity and for cosmetic reasons. Techniques are complicated and require expert care when being administered. When used correctly, they can demonstrate a tremendous result.
Botox is a toxin that is produced by the bacterium Clostridium botulinum. The injection form used in treatments is the sterile lyophilised form of botulinum toxin type A. There a variety of formulations available on the market these days, and most of them are used for the same purposes. In a nutshell, they are useful to get rid of wrinkles on the face (cosmetic purposes), in managing spasticity associated with cerebral palsy, spastic paraparesis, blepharospasm and also for the management of pain.
Botulinum toxin is delivered as an injection to the relevant muscle groups, and in this article we will look at the injection techniques in a bit more detail.
The Technique of Botox injection administration
The general technique for injecting Botox consists of using a 1.0 mL Tuberculin type syringe along with needles of varying size depending on the muscle being injected. For superficial injections into the skin and the muscles around the eye, a short 25 gauge to 30 gauge needle may be used. However, for larger muscles, a longer 25 gauge may be used.
Prior to performing the procedure, it is essential to identify the right muscle or muscle groups that require injecting. A thorough clinical examination is warranted, and once this is concluded electromyography studies may be conducted to identify the muscles clearly. Once this has been done, a motor point should be identified on the surface of the muscle. This is the point that is injected with Botox. The skin is cleaned with alcohol and the alcohol allowed to evaporate. The toxin is then injected into the muscle, taking care not to inject it intravascularly.
The time duration taken to inject the toxin depends on the operator experience and the number of muscles that need injecting. Following the procedure, patients may feel a mild amount of pain and discomfort, and this is easily treated with simple analgesics.
Let's take a look at a couple of clinical conditions that require Botox injections.
1. Cerebral palsy
Target muscles that are spastic in children with cerebral palsy (CP) need to be identified using gait analysis. While passive movement of the muscles and joints can help identify muscle groups that need injecting, some groups advocate using ultrasound with or without electromyography to ensure accuracy. Following the injection, the appropriate post injection care such as physical therapy and orthotic management should be considered.
2. Blepharospasm
Here, Botox is diluted with normal saline and is injected using a 30 gauge needle into the orbicularis oculi muscle carefully at around 4 to 5 points around the eye. Care should be taken to ensure ptosis does not occur during injection.
There are many more conditions and a detailed discussion on each of these is out of scope of this article.
Botox injections are common practice in managing muscle spasticity and for cosmetic reasons. Techniques are complicated and require expert care when being administered. When used correctly, they can demonstrate a tremendous result.
About the Author:
Train for Botox injection procedures with the IAPAM. Find all you need to know about Medical Aesthetic Training at www.iapam.com.
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