眼瞼痙攣・片側顔面痙攣に対するボツリヌス毒素施注の要領 (医学部神経内科学教室 内山真一郎教授退任記念特別号)  [in Japanese] Key Points in Botulinum Toxin Injection for Blepharospasm and Hemifacial Spasm  [in Japanese]

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Author(s)

    • 大澤 美貴雄 Osawa Mikio
    • 東京女子医科大学医学部神経内科学 Department of Neurology, Tokyo Women's Medical University School of Medicine

Abstract

ボツリヌス毒素療法は、眼瞼痙攣と関連疾患の開眼失行、および片側顔面痙攣と関連疾患の顔面連合運動の第一選択治療である。本稿で最初に、これらの疾患で本治療の標的になる顔面筋の始点と終点について記述した。次に標的筋、すなわち前頭筋、鼻根筋、皺眉筋、眼輪筋、眼瞼部、鼻筋、小頬骨筋、大頬骨筋、笑筋、口輪筋、オトガイ筋、広頸筋、それぞれの同定法を紹介した。副作用を未然に防止する為に、避けるべき標的筋の部位について強調した。また、本薬の効果を向上させる為に本薬、を各標的筋にどのように配分するかを紹介した。本薬の標的筋における1施注部位当たりの平均投与量は0.625単位から5単位であり、各標的筋の1〜4部位に施注する。但し、初回の施注量は、副作用予防の観点から必要最低限とする。,ボツリヌス治療成績を向上させるには、標的筋の機能解剖学を熟知し、適切な施注筋の同定・選定と標的筋への同薬配分が必須である。

Botulinum toxin therapy is the first line treatment for blepharospasm and its related disorder apraxia of eyelid opening, and for hemifacial spasm and its related disorder facial synkinesis. First, I describe the beginning and ending points of individual facial muscles which may be the target of botulinum toxin injections for the above mentioned disorders. Next, I introduce how to identify target muscles including the orbicularis oculi, corrugator, procerus, zygomaticus major, zygomaticus minor, orbicularis oris, risorius, mentalis, platysma, transverse portion of nasalis, and frontalis muscles. I emphasize the need to avoid injecting the toxin into some parts of the target muscles in order to prevent undesirable side effects. For example, the toxin should not be injected into the center of the upper eyelid in order to avoid blepharoptosis due to paresis of the levator palpebrae superioris muscle. I also explain how to distribute the toxin to the target muscles in order to improve the effectiveness of the therapy. For example, botulinum toxin is injected into each border of 3 or 4 portions of the platysma equally divided between the anterior and posterior edges of the middle portion between the chin and the clavicle. An average dose is 0.625 to 5 units injected into 1 to 4 divided points of the target muscle, with the first injection being the minimum.,To improve the effectiveness of botulinum toxin therapy, I emphasize the importance of knowing the functional anatomy of the facial muscles, which enables proper identification and selection of the target muscles, and stress the proper distribution of the toxin to the target muscles.

Journal

  • Journal of Tokyo Women's Medical College

    Journal of Tokyo Women's Medical College 84(臨増), E17-23, 2014-01

    Tokyo Women's Medical University

Codes

  • NII Article ID (NAID)
    110009752549
  • NII NACSIS-CAT ID (NCID)
    AN00161368
  • Text Lang
    JPN
  • Article Type
    journal article
  • Journal Type
    大学紀要
  • ISSN
    0040-9022
  • NDL Article ID
    025459710
  • NDL Call No.
    Z19-400
  • Data Source
    NDL  NII-ELS  IR 
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