Botox Procedures
Botox (botulinum toxin type A or onanbotulinum toxin A) is an injectable toxin that temporarily blocks nerve transmission (neurotoxin). According to the Botox package insert, it is derived from the the toxin of the bacterium that causes food poisoning (Clostridium botulinum). It is considered a muscle-relaxing drug that blocks electrical impulses from the nerve endings, causing the muscle to contract (chemical denervation). Botox procedures involves medication preparation, muscle identification and localization and post-procedure care and monitoring.
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Significance
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Botox is used to treat a variety of conditions, including nerve disorders, abnormal muscle contractions and other neuromuscular disorders. It is also used to treat excessive sweating and in cosmetic procedures to decrease visible wrinkles in the skin.
Preparation
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A physician identifies sites of injection on a patient (for example, facial, underarm, palm or neck areas). These sites are marked on the patient for easy targeting. The physician prepares Botox by adding sterile saline to the vial to create a diluted formulation of the neurotoxin. A single-use syringe draws the diluted product for injection. According to the Botox package insert, the preparation must be refrigerated after saline is added and used within four hours.
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Thinner Skin
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To prepare the patient for injections, sometimes a topical anesthetic is applied (however, it may not be applied because of possible skin sensitivities). Botox is injected under the skin (subdermal) to target superficial muscles such as on the face, hands and underarms. For example, the Botox package insert outlines an injection depth of approximately two millimeters inserted at a 45-degree angle for hyperhidrosis (excessive sweating). The physician injects a small amount of the diluted substance into each targeted location, taking care to avoid injecting into inked markings, which would cause a tattoo effect.
Dystonia Pain
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The pain associated with dystonia is attributed to muscle over-contraction because electrical impulses are stimulating the neck muscles. The physician marks this area and uses an electromyograph (EMG) machine to monitor the electrical impulses in the muscle. A probe is inserted into the muscle to measure its activity. A strong signal indicates that the muscle is contracting. The physician uses this information to identify the muscle and depth for the injection (a localization technique). Special care is needed in the neck area to avoid spreading the neurotoxin to other muscles such as jaw muscles. For deeper muscle injections to treat dystonia, a topical anesthetic may not be necessary because the patient is already feeling severe pain.
Post-Procedure
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Patients are monitored for potential side effects that could be associated with the drug such as allergic reactions, flu-like symptoms, unusual weakness or numbness. Since multiple injections are usually administered, basic wound care may be necessary for the injection sites. Depending on the procedure, therapy may be prescribed to maintain the muscle's flexibility while it is in a relaxed state. Regular monitoring of the condition enables the patient and physician to determine whether additional treatment with Botox is needed, and the time frame of effect.
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