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Title: Botulinum toxin type A as an adjunct treatment to radiation-induced trismus
Authors: ANDRADE, R. G.LIMA, M. C.BRITO, C. M. M.
Citation: TOXICON, v.68, p.105-105, 2013
Abstract: Purpose of study: To report a case of trismus (lockjaw) that began after completion of radiation therapy for head and neck cancer that we treated with botulinum toxin type A. Methods used: Case report. Summary of results: A white woman, 60 years old, was diagnosed with squamous cell carcinoma (SCC) of the left oral mucosa in April 2010. She underwent resection of the SCC in June 2010 with neck dissection and construction of a left supraclavicular flap. Subsequently, she underwent radiotherapy from 25 October 2010 to 14 December 2010. About 30 days after the radiation therapy, she noticed a decreased range of motion associated with jaw pain, and she experienced difficulty with feeding and oral hygiene. She was referred to speech therapy for rehabilitation but had little improvement. In our first physiatric evaluation on 13 June 2011, we identified a maximal inter-incisal distance of 0.5 cm, pain score assessed by visual analog scale (VAS) of 4, and Short Form 36 (SF-36) score of 676. We requested a facial and temporomandibular joint MRI, which eliminated recurrence of disease, osteonecrosis and muscle fibrosis as possible causes of the trismus. We chose to treat her trismus with botulinum toxin type A (Prosigne®, Lanzhou Biological Products Institute, Lanzhou, China), with 60 U in the masseter and 40 U in the temporalis muscle, with resumption of the speech therapy exercises while we monitored the toxin therapy. Two weeks after injection, the patient showed a maximal inter-incisal distance of 2.0 cm, a 2-point improvement in the VAS, an improved SF-36 score of 742, and she reported relief of pain. She even reported complete resolution of a previous headache, which she had not mentioned in her first evaluation. Conclusions: We suggest the use of botulinum toxin type A as an adjunct treatment to radiation-induced trismus, especially in severe cases that are refractory to conventional treatment. Trials with this treatment are indicated in order to evaluate the role of BTX-A in trismus.
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Comunicações em Eventos - HC/ICESP
Instituto do Câncer do Estado de São Paulo - HC/ICESP

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