Global Journal of Medical Research, I: Surgeries and Cardiovascular System, Volume 22 Issue 2

Traumatic Facial Injury Treated by Botulinum Toxin A Honório Sampaio Menezes α , Danuza Dias Alves σ , Roberto Chacur ρ , Rodrigo Cadore Mafaldo Ѡ , Nívea Maria Bordin da Silva Chacur ¥ , Leandro Dias Gomes § , Vicenzo Stein de Vargas χ , Giulia Casa Nova Barbosa ν , Gabriella Andressa Marchesin de Castro Ѳ & Manuela Guimarães Dias Gomes ζ Abstract- Introduction: Botulinum toxin type A (BTA) is used in the treatment of various medical and aesthetic conditions. The mechanism of action of the drug includes action on fibroblast stimulation, decrease of wound tension and production of collagen. Objective: This study aimed to demonstrate the use of botulinum toxin as a possible treatment for reducing facial scarring. Methods: It was a retrospective study involving patients who were treated with BTA for the management of facial scars. Conclusion: Botulinum toxin A is efficient for the treatment and reduction of facial scars resulting from trauma or surgical interventions. Keywords: botulinum toxin A, facial scarring, wound healing, wound tension. I. I ntroduction kin lesions by surgeries or trauma results in the formation of scars. Facial scars have psychological effects, as they are impossible to hide, the main clinical objective of the treatment is being to repair the skin and minimize the scar. Surgeons expends time to improve the aesthetic appearance of the skin during repair of trauma or surgery 1,2 . However, most techniques used for scar reductions reduce, instead of eliminating, the muscular system acts on the scar. The underlying musculature produce a hard tension over the wound, therefore, these muscles must be paralyzed using botulinum toxin A (BTA). BTA blocks the acetylcholine release at the neuromuscular junction, producing paralysis 1,3,4,5 . BTA is useful to treat of various medical conditions, and increasingly used in aesthetic medicine. The action of the drug includes diminish wound tension, Author α : Physician, PhD, SCd., Clínica Leger, Rio Grande do Sul, Brazil. Author σ : Physician Clínica Leger, Rio Grande do Sul, Brazil. e-mail : nucleodepesquisa@clinicaleger.com.br Author ρ : Physician, Specialist, Clínica Leger, Rio de Janeiro, Brazil. Author Ѡ : Physician, PhD., Clínica Leger, Rio Grande do Sul, Brazil. Author ¥ : Physician, Clínica Leger, Rio de Janeiro, Brazil. Author § : Physician, PhD., Clínica Leger, Rio Grande do Sul, Brazil. Author χ : Physician, Clínica Leger, Rio Grande do Sul, Brazil. Author ν Ѳ : Biomedical, Clínica Leger, Rio Grande do Sul, Brazil. Author ζ : Medicine Student, Clínica Leger, Rio Grande do Sul, Brazil. collagen production, and fibroblasts growth. BTA also works inhibiting the presynaptic release of acetylcholine, as it acts at the neuromuscular junction 2,3,4,5,7 . The administration of BTA causes muscle paralysis which may last from two to six months. It has been used for medical purposes since the 1980s and the use of BTA in the treatment of pathological scars was first reported in 2000. To date, its mechanism is still not clearly understood. In recent years, an increasing number of doctors have preferred intralesional BTA for the prevention and treatment of hypertrophic scars and keloids combined or not with other therapy 2, 3,4,5,7 . The mechanism of wound healing is sophisticate and simultaneous process occurs in three stages: inflammation, granulation tissue formation, and matrix formation. If there are changes in these healing stages, it may result in the formation of pathological scars 1,2,3,7 . The most important factor that defines the appearance of a scar is the force tension over the wound edges during the healing process. The injection of BTA reduces the perpendicular tension on the wound edges and muscular force over the skin, inhibiting the formation of hypertrophic scars and keloids. BTA allows almost complete inhibition of dynamic muscle tension in the edge of the wound during the healing process 2,3,5,6,7 . The present study aimed to demonstrate the use of botulinum toxin as a possible treatment for reducing facial scarring. II. M ethods This is a retrospective study involving patients treated at clinic who were treated with BTA the management of facial wounds. Qualitative analyses of the evolution of the treated patients were performed. Study approved by the Research Ethics Committee of the Veiga de Almeida University under protocol number 29151320.0.0000.5291. Clinical Case 1 30-year-old female, had an accident riding a bicycle. She injured her forehead and was treated in the emergency room. On the following day, she went to the clinic concerned with the aesthetic effect of the injury. S 43 Year 2022 Global Journal of Medical Research Volume XXII Issue II Version I ( D ) I © 2022 Global Journals