Learning objectives
To review the indications for and benefits of ultrasound-guided botulinum toxin A to provide targeted paralysis of select muscles.
Background
In recent years,
ultrasound-guided injection of botulinum toxin A (botox) has emerged as an invaluable method for providing targeted therapeutic paralysis of select muscles.
An increasingly common usage for botox for temporary muscle paralysis outside of the realm of cosmetics is within the lateral abdominal wall muscles prior to ventral hernia repair surgery. Surgical management of ventral hernias can be challenging,
with high morbidity rates as well as high rates of hernia recurrence even with laparoscopic techniques. Chronic lateral abdominal wall muscular contraction and retraction...
Imaging findings OR Procedure Details
Lateral abdominal wall muscular anatomy and general approach for ultrasound guided botox injection prior to ventral hernia repair surgery is shown in Figure 1. Abdominal muscular anatomy on computed tomography (CT) in a patient with ventral hernia is shown in Figure 2. At our institution,
ultrasound guided botox injection of the lateral abdominal wall muscles is commonly performed 3-4 weeks prior to the date of surgery for ventral hernia repair (Figure 3).
Our procedural technique: Pre-procedural ultrasound should be obtained to clearly identify the three...
Conclusion
Ultrasound-guided injection of botulinum toxin A has emerged as a successful method for providing targeted therapeutic paralysis of muscle groups of interest.
Its usage varies from preoperative optimization for hernia repair surgery to the treatment of chronic spasticity and myofascial pain.
The procedure is relatively inexpensive and simple to perform given adequate ultrasonography training.
Further research is needed to expound upon the utility and indications for intramuscular botox injections.
References
1) Rodriguez-Acevedo,
O.,
Elstner,
K.E.,
Jacombs,
A.S.W.,
Read,
J.W.,
Martins,
R.T.,
Arduini,
F.,
Wehrhahm,
M.,
Craft,
C.,
Cosman,
P.H.,
Dardano,
A.N.,
et al.
(2018).
Preoperative Botulinum toxin A enabling defect closure and laparoscopic repair of complex ventral hernia.
Surg Endosc 32,
831–839.
2) Farooque,
F.,
Jacombs,
A.S.W.,
Roussos,
E.,
Read,
J.W.,
Dardano,
A.N.,
Edye,
M.,
and Ibrahim,
N.
(2016).
Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair.
ANZ J Surg 86,
79–83.
3) Soltanizadeh,
S.,
Helgstrand,
F.,
and Jorgensen,...
Personal Information
Swati Deshmukh,
MD
Assistant Professor
Department of Radiology
Division of Musculoskeletal Imaging
Northwestern University
Northwestern Medical Group
Northwestern Medicine Spine Center
676 N.
Saint Clair Street,
Suite 800
Chicago,
Illinois 60611