Rainer Laskawi

Up-to-date Report of Botulinum Toxin Type A Treatment in Patients With Gustatory Sweating (Frey's Syndrome)

Several therapeutic approaches exist to treat gustatory sweating (Freys syndrome) following parotidectomy. Because of the lack of effective treatment, a new therapeutic modality using botulinum toxin injections was presented previously by our group. The duration of the demonstrated positive effect was essentially unknown so far. Based on our experiences using this technique since December 1993, the purpose of this clinical investigation was to make an up‐to‐date report and demonstrate the duration of effect of BOTOX injections in patients with severe gustatory sweating. Nineteen patients with severe gustatory sweating have been treated with BOTOX by intracutaneous injections into the affected skin areas. The maximal follow‐up time was 33 months. The results were obtained by interviews and controls using Minors starch iodine test. In all treated cases (n = 19 patients, 22 treated sides) gustatory sweating ceased completely within 2 days. Side effects were absent. In 12 patients gustatory sweating reappeared. The mean duration of effect was 17.3 months (subjective personal communication of 18 patients). Findings show that intracutaneous injection of BOTOX is a highly effective, safe, and minimally invasive treatment of Freys syndrome with long‐lasting therapeutic effect.

Reduction of Salivary Flow With Botulinum Toxin: Extended Report on 33 Patients with Drooling, Salivary Fistulas, and Sialadenitis

Objectives/Hypothesis: The aim of the study was the evaluation of the clinical data of 33 patients who had had drooling attributable to various diseases, salivary fistulas, and sialadenitis and had been treated with injection of botulinum toxin type A (Botox). A controlled follow‐up study documenting efficiency, possible side effects, and duration of the effect of treatment was also performed.

Botulinum toxin to reduce saliva flow: selected indications for ultrasound-guided toxin application into salivary glands.

Objectives/Hypothesis The study investigates the effect of local injections of botulinum toxin type A (Botox) into the major salivary glands of the head in various states of hypersalivation. In particular, we studied pathological states with permanent as well as passing hypersalivation disorders and present new indications for local application of botulinum toxin to the salivary glands.

Astrocytes as rapid sensors of peripheral axotomy in the facial nucleus of rats

Facial nerve transection leads to functional and structural reactions in lesioned motor neurones and surrounding glial cells. Data from this study provide evidence that the most rapid reaction described so far consists of an increase in immunoreactivity of connexin-43 (cx-43), the predominant gap junction protein in astrocytes. The ipsilateral facial nucleus is selectively marked as early as 0.75 to 1.5 hours after axotomy, while the unlesioned side as well as the unoperated controls remain faintly stained. Thus, enhanced coupling capacity of astrocytes by gap junctions appears to be a sensitive indicator of modified neuronal-glial interaction in the CNS.

Facial nerve lesions lead to increased immunostaining of the astrocytic gap junction protein (connexin 43) in the corresponding facial nucleus of rats

After peripheral transection of the facial nerve, immunostaining of astrocytic gap junction protein changed in the corresponding brainstem nucleus of the rat. Enhanced connexin-43 immunoreactivity was restricted to the ipsilateral facial nucleus and to astrocytes surrounding lesioned motoneurons. This reaction is focally distinct, and marks only a part of the astrocytic network indicating a local plasticity of intercellular coupling. These results suggest that astrocytes work as sensors of signals which either depend on the integrity of neighboring neurons or inform about neuronal disorders.

Surgical management of pleomorphic adenomas of the parotid gland: A follow-up study of three methods

PURPOSE This retrospective study evaluated data pertaining to history, symptoms, diagnosis, and mode of therapy of patients treated for pleomorphic adenoma of the parotid gland. PATIENTS AND METHODS The records of 475 patients were reviewed. Follow-up was done by questionnaires sent to the referring doctor. RESULTS The total rate of recurrence was 0.9% after 475 operations for pleomorphic adenoma of the parotid gland. One recurrence (0.7%) was reported for the group with superficial parotidectomy and none for the group with total parotidectomy. The rate of postoperative side effects was also low. The facial nerve was affected in 1.4% after superficial parotidectomy, and in 3.3% after total parotidectomy. CONCLUSION The results of this follow-up study show that superficial parotidectomy for pleomorphic adenoma located in the superficial lobe of the parotid gland provides adequate therapy and generally avoids recurrence and side effects.

Botulinum toxin type A induces apoptosis in nasal glands of guinea pigs.

Nasal hypersecretion is predominantly caused by overaction of nasal glands, which are mainly under cholinergic control. In this work, we investigated the influence of botulinum toxin A (BTA) on the nasal mucosal tissue of the maxillary sinus turbinates of guinea pigs (n = 10) that were painlessly sacrificed 10 days (short-term group) or 3 months (long-term group) after local treatment with 20 units of BTA (Botox) or 0.2 mL of 0.9% sodium chloride (control). Histologic investigation of the nasal mucosal tissue of the BTA-treated animals (short-term group) showed degeneration of glands and ducts and apoptotic nuclei on TUNEL staining of these structures. The control animals revealed normal glandular tissue and no apoptosis. The animals of the long-term group showed almost normal glandular tissue and only a few apoptotic nuclei. In conclusion, BTA induces temporary apoptosis in the nasal glandular compartment of guinea pigs.

Biphasic reorganization of somatotopy in the primary motor cortex follows facial nerve lesions in adult rats.

Effects of facial nerve transection were studied on muscle responses evoked by electrical stimulation in the primary motor cortex (MI) of adult rats. In intact animals, activated muscles varied according to the somatotopic representation map, and responses were restricted to the contralateral side. Unilateral transection of the facial nerve extinguished contralateral vibrissal responses, while ipsilateral vibrissae began to respond within 4 min. This abnormal response (primary change) was transient and gradually disappeared within hours to days. Instead, contralateral movements of forepaw and eye/eyelid muscles could be evoked from increasing portions of the former vibrissal field (secondary change), in which many points became unresponsive. After 4 days, the former vibrissal field had shrunk to a small central part, where ipsilateral vibrissae responsiveness remained. The secondary modification was stable for at least 2 weeks. Since the primary change is rapid, transient and may be mimicked by picrotoxin, it may be based on disinhibition of commissural connections, while the secondary change is longlasting and therefore may include some form of reorganization of associational synapses.

Recurrent pleomorphic adenomas of the parotid gland: clinical evaluation and long-term follow-up

We report 94 patients with recurrent pleomorphic adenomas of the parotid gland who were referred to our clinics after operations elsewhere. In 78 patients (83%) enucleation was the surgical technique used to remove the tumour. Patients with more than one recurrence were significantly younger than patients who had only one. Many recurrent adenomas (44%) were multifocal. In 20 (21%) further recurrences became obvious after we had operated on them. The mean time interval before recurrence ranged from 7.3 to 10.1 years. Twenty patients (14%) had persistent motor disorders of the facial nerve after operation for recurrence (n = 143). Twenty eight of the 84 patients from whom follow-up data could be obtained developed Freys syndrome (33%). Our data support the importance of an adequate initial operation to avoid recurrences of pleomorphic adenomas in the parotid gland.

Surgical management of nonneoplastic diseases of the submandibular gland: A follow-up study

A total of 233 patients with nonneoplastic diseases of the submandibular gland were treated between 1966 and 1992 at the otorhinolaryngology department of the University of Göttingen. Of them, 212 patients (91%) suffered from sialadenitis with or without sialolithiasis, and 21 (9%) suffered from other diseases. The first part of the present study analyzes the clinical data with regard to history, symptoms, and therapy. It was found that in most cases (77%) extirpation of the affected gland had been the standard operation. In the second part, the surgical procedures applied are critically assessed. Extirpation of the submandibular gland proved to be an effective therapy in all patients. Side-effects were rare. The management of chronic sialadenitis caused by calculi should include extirpation of the submandibular gland. In case of calculi not causing inflammatory disease, lithotripsy should be considered.