Toxina botulínica para correção de assimetria facial após paralisia de Bell - relato de caso

Abstract

Bell's facial paralysis is a lesion of the VII cranial nerve that causes unilateral paralysis of the facial muscles. It starts suddenly and its cause may be related to several factors, in many cases the patient suffers facial asymmetry as a result. Botulinum toxin, a neurotoxin, produced by the Clostridium botulinum bacterium, is a resource for treating this condition, whereby relaxing the facial muscles on the unaffected side we restore facial balance as well as the patient's selfesteem and quality of life. The objective of this study is to describe the procedure for applying TBA in a long-standing case of Bell's Palsy, considering the patient's complaints, expectations and treatment considerations. A 64-year-old female patient attended the initial data collection consultation regarding her history of paralysis, the treatment plan was explained, possible results, the free and informed consent forms were signed and initial photographic protocol were filled in. The commercial brand "Dysport 500U'' botulinum toxin was administered with a total of 30U, the amount per point being defined considering the muscle tone of each region of the right hemiface when compared to the paralyzed left side, and 3 methods of pain relief were used (topical anesthetics, massager device close to the application area and “anti-stress” ball”). Return visits were made 4, 14 and 32 days after the procedure for photographic protocol and the application of a complementary dose to the orbicularis oculi muscle on the 14-day return visit was necessary. Despite not having achieved total reestablishment of symmetry, there was a satisfactory aesthetic improvement which led to an increase in the patient's self-esteem and confidence in social interaction, then it can be concluded that treatment with TBA to correct facial asymmetry by Bell's Palsy is effective and has the capacity to improve the quality of life of patients with asymmetry, but further studies are important to establish standardized protocols.