A 62-year-old female patient diagnosed with left brain stem stroke 2 months ago was admitted to our clinic for rehabilitation. She had no generalized spasticity on both extremities, but could open her mouth only approximately 2 mm between her upper and lower teeth due to severe trismus. On needle electromyography, the left masseter muscle showed paradoxically increased muscle activity during mouth opening. We injected 50 units of type A botulinum toxin (Botox®) into the left masseter muscle, and 20 units into the left temporalis muscle with guidance of ultrasonography. The interincisal distance increased to 8 mm on the 3rd day after injection, and 9 mm on the 4th day. One month later, the interincisal distance increased to 14 mm. The increased interincisal distance was maintained for 13 months after injection, and the quality of hygienic care and compliance of oral stimulation therapy also improved.
Citations
Citations to this article as recorded by
Impact of Hemorrhagic Stroke on Molar Bite Force: A Prospective Study Gabriel Pádua da Silva, Edson Donizetti Verri, Marcelo Palinkas, Camila Roza Gonçalves, Paula Napolitano Gonçalves, Robson Felipe Tosta Lopes, Guilherme Gallo Costa Gomes, Isabela Hallak Regalo, Selma Siéssere, Simone Cecilio Hallak Regalo Prague Medical Report.2022; 123(3): 181. CrossRef
Handling and progress until achieved oral ingestion against dysphagia of congenital pseudobulbar palsy Satoko Yamaguchi, Akiko Ishizaki, Kohji Murakami, Shouji Hironaka Pediatric Dental Journal.2021; 31(2): 197. CrossRef
Out of the spasticity box: Off-label uses of botulinum toxin in children Joyce L. Oleszek, Amy S. Kanallakan, Aaron J. Powell, Deborah Gaebler-Spira, Michael M. Green Journal of Pediatric Rehabilitation Medicine.2020; 13(2): 205. CrossRef
Functional outcome of swallowing rehabilitation in 4 dysphagic patients with stroke presenting with dysphonia, severe pseudobulbar palsy, and trismus Taro Ogawa Nosotchu.2016; 38(5): 319. CrossRef