Techniques of Botulinum Toxin Injections

By Pauline Perrinote

As we all called them, Botox injections, are being used very often these days. They are probably considered the best and more useful part of a cosmetic makeover. But it seems, people don't only use it for that, it is extremely useful in managing different clinical conditions such as muscle spasticity.

Maybe one of the best known injectables for cosmetic procedures these days, botox is produced by the bacterium Clostridium botulinum. There are many different formulations on the market today, and maybe almost all of them are being used for one purpose only. We all know they are perfect for wrinkles - so cosmetic uses is the most known use. We also use it for, spastic blepharospasm, paraparesis, blepharospasm and though not well known, we use it for the management of pain.

Botulinum toxin is delivered as an injection to the relevant muscle groups, and in this article we will look at the injection techniques in a bit more detail.

The Injection Technique

The general technique for injecting Botox consists of using a 1.0 mL Tuberculin type syringe along with needles of varying size depending on the muscle being injected. For superficial injections into the skin and the muscles around the eye, a short 25 gauge to 30 gauge needle may be used. However, for larger muscles, a longer 25 gauge may be used.

Prior to beginning the procedure, it's essential to spot the proper muscle or muscle teams that require injecting. An intensive clinical examination is performed, and once this is completed, electromyography studies could also be conducted to spot the muscles clearly. Once this has been done, a motorpoint should be identified on the surface of the muscle.This is often the target area that's injected with botulinum toxin A. The skin is cleansed with alcohol and the alcohol allowed to evaporate. The toxin is then injected into the muscle.

Wait time depends on the operator experience. Of course, the number of muscles you need to inject is also important. These are the right steps of the proper procedure, after that your patients may feel a pain or at least discomfort, but you can control it with simple analgesics. And that is nothing difficult.

Let's take a look at some of the clinical conditions that can utilize botox injections.

1. Cerebral palsy

Target muscles that are spastic in children with cerebral palsy (CP) need to be identified using gait analysis. While passive movement of the muscles and joints can help identify muscle groups that need injecting, some groups advocate using ultrasound with or without electromyography to ensure accuracy. Following the injection, the appropriate post injection care such as physical therapy and orthotic management should be considered.

2. Blepharospasm

Botox has to be very gently injected using a 30 gauge needle into the orbicularis oculi muscle. That should be done very carefully and right next to the eye.

There are many more conditions and a detailed discussion on each of these is out of scope of this article.

Botox injections are very popular. They are used for managing muscle spasticity and women mostly use them for cosmetic reasons. The techniques are not complicated but one needs to be trained for this specific procedure.

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