Saskia Rohrbach

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.

Minimally Invasive Application of Botulinum Toxin Type A in Nasal Hypersecretion

We report on the effect of the local application of botulinum toxin A on nasal hypersecretion in a female patient with intrinsic rhinitis. 20 units of botulinum toxin A (Botox®) was inserted into each nostril using a small sponge in close contact with the lower and middle turbinates. The effect was scored by the patient and by rhinomanometry. Nasal hypersecretion diminished clearly 5 days after the treatment. The rhinomanometric flow increased 2 weeks after the application. No side effects occurred. We conclude that this minimal invasive method of local botulinum toxin application might be a very effective and safe option for the treatment of nasal hypersecretion of different etiologies.

Treatment of Gustatory Sweating with Botulinum Toxin: Special Aspects

Botulinum toxin treatment is an efficient, well-tolerated technique for patients suffering from gustatory sweating, first described by our group. With the experience gained in recent years we were able to improve on some of our skills in the diagnosis and treatment of gustatory sweating and here we wish to focus on some interesting aspects: (1) the necessity for an exact anamnesis before treatment with botulinum toxin to ensure correct treatment; (2) the advantages of Minor`s test in special situations, for example, when sweating occurs in regions of hairy skin, retroauricular, at the back of the auricle and in areas distant from the site of salivary gland surgery; (3) the reduction of pain during treatment using an anesthetic ointment containing lidocaine and prilocaine as active substances; (4) intracutaneous injections in areas anterior to the fascia-protected skin of the lateral face-covering mimetic muscles, and (5) the occasional necessity for short-time reinjection in small areas of persistent sweating.

Neuronal Nitric Oxide Synthase Immunoreactivity in the Nasal Mucosa of Patients with Idiopathic and Allergic Rhinitis

The localization of neuronal nitric oxide synthase (nNOS) in the mucosa of the inferior and middle turbinates of 30 patients with and without allergic rhinitis was examined by immunohistochemical methods. Staining of paraffin sections from allergic and nonallergic patients revealed nNOS immunoreactivity (nNOS-IR) in the muscular layer of vessels, in the basal portion of submucosal glands and in the periost and the osteocytes of the turbinate bones. In contrast to earlier investigations, nNOS-IR was also seen in the nasal respiratory epithelium of allergic and nonallergic patients. The immunostaining of sections of submucosal glands from allergic patients was stronger than that of sections from patients with idiopathic rhinitis or patients with no nasal obstruction. The present result – nNOS-IR around glands is elevated in patients with allergic rhinitis – could indicate that this enzyme is involved in the pathogenesis and symptomatology of allergic rhinitis.

Neuronal Nitric Oxide Synthase-Immunoreactivity

The influence of botulinum toxin type A (BTA) on cellular mechanisms has not been studied in much detail. Since nitric oxide (NO) is of increasing interest as a neuromodulator in the innervation of the nose, its localization was examined in the nasal mucosa of guinea pigs treated with BTA or saline. Neuronal nitric oxide synthase-immunoreactivity (nNOS-IR) was found around vessels and nasal glands. Immunoreactivity was seen in the respiratory epithelium, in the periost and the osteocytes of the turbinate bone. A distinct interindividual difference in the strength of nNOS-IR was obvious among the animals, but there was no difference in the strength of immunoreactivity between the animals treated with BTA or saline. NO might therefore contribute to the regulation of vascular tone, glandular function, respiratory epithelial cell function and bone metabolism. BTA does not seem to influence the processes regulated and modulated by NO. This may represent a benefit for the application of BTA.

Improvement of chronic facial pain and facial dyskinesia with the help of botulinum toxin application.

BackgroundFacial pain syndromes can be very heterogeneous and need individual diagnosis and treatment. This report describes an interesting case of facial pain associated with eczema and an isolated dyskinesia of the lower facial muscles following dental surgery. Different aspects of the pain, spasms and the eczema will be discussed.Case presentationIn this patient, persistent intense pain arose in the lower part of her face following a dental operation. The patient also exhibited dyskinesia of her caudal mimic musculature that was triggered by specific movements. Several attempts at therapy had been unsuccessful. We performed local injections of botulinum toxin type A (BTX-A) into the affected region of the patients face. Pain relief was immediate following each set of botulinum toxin injections. The follow up time amounts 62 weeks.ConclusionBotulinum toxin type A (BTX-A) can be a safe and effective therapy for certain forms of facial pain syndromes.