Internal anal sphincter achalasia (IASA) is a rare anorectal disorder that presents as chronic refractory constipation in pediatrics. With a poor response to conventional constipation-based therapy, it is often misdiagnosed as other conditions, such as ultra-short-segment Hirschsprung disease. This case report describes a rare case of IASA in an adolescent female, emphasizing the importance of ruling out other differentials, including Hirschsprung disease, via rectal biopsy and thus allowing for earlier targeted therapy to improve lifestyle conditions. A 20-year-old female with a history of IASA presents for semiannual botulism toxin injections. Despite initial relief, her constipation symptoms gradually returned after four to five months. She has had a history of ineffective conventional constipation treatments since childhood, which prompted a further workup. Biopsy results during her teenage years confirmed the presence of ganglionic cells, differentiating IASA from Hirschsprung disease. The management plan involved biannual perianal Botox injections, offering relief for approximately six months. IASA\'s physiological basis involves altered innervation, the absence of nitrergic nerves, and defective neuromuscular junctions in the internal anal sphincter. Diagnosis requires anorectal manometry and a rectal suction biopsy. Treatment options include botulism, toxin injections, and posterior internal anal sphincter myectomy. Botulism injections offer temporary relief, while myectomy provides long-term improvement.

We report the case of a 24-year-old woman who was referred to one of the authors\' clinics after six days of botulinum toxin type A injection to treat dynamic lines on her forehead, glabella complex, and crow\'s feet area. Her first esthetic injection was done by another colleague elsewhere in a different clinic. Her main complaint was full eyelid ptosis, which started four days after her treatment and continued to aggravate until the time she sought our help. We treated it with another dose of botulinum toxins. The patient started to notice a gradual improvement in her eyelid five days after our injection, so on day 14th, her eyelid was very closely back to normal opening; complete recovery was achieved. Ptosis due to botulinum toxin injection was surprisingly and successfully reversed in our article by a second dose of botulinum toxins. This suggests that this management successfully treats such cases and can deliver a beneficial reversal option for practitioners and their patients. The case report concludes that ptosis should be promptly evaluated and treated through a multimodal approach.

In this literature review, we will evaluate the effectiveness of OnabotulinumtoxinA (Botox) and anti-calcitonin gene-related peptide (anti-CGRP) in the treatment of migraine headaches. Both therapies are frequently prescribed for managing and preventing migraines and have received Food and Drug Administration (FDA) approval. The mechanism of action, side effects, compliance, cost-effectiveness, and migraine treatment provided by these two medicines were compared in the analysis of several studies. Many studies found that as Botox was administered by a doctor every three months and had fewer side effects than anti-CGRP, which is self-administered every month, it was more compliant than anti-CGRP. After examining the data, Botox is believed to be the most effective therapy. Although both therapies are efficient, this article compares them to determine which is the best management strategy.

Neuralgia is characterized by chronic pain resulting from damage or diseases in the somatosensory system, including nerves responsible for transmitting sensory information. Current treatments for neuropathic pain, which is a type of neuralgia, have limited success rates and can cause unwanted side effects. Since 1989, botulinum toxin-A (BTX-A), derived from the potent neurotoxin Clostridium botulinum, has been used to treat neuropathic pain in humans. BTX-A has shown analgesic effects by inhibiting the release of neurotransmitters involved in pain transmission. This review aims to evaluate the effectiveness of BTX-A in various types of neuralgia. The research question guiding this review is whether BTX-A is safe and effective in reducing pain in different types of neuralgias. To conduct this review, a literature search was performed using the PubMed, Medline, and PubMed Central databases. The search strategy included relevant keywords related to BTX-A, neuralgia, and neuropathic pain. After screening titles, abstracts, and full texts, a total of 30 articles were included in the review. These studies examined the efficacy of BTX-A in various conditions such as postherpetic neuralgia (PHN), auriculotemporal neuralgia (ATN), occipital neuralgia (ON), leprosy-induced neuropathic pain (LIN), focal painful neuropathies, complex regional pain syndrome (CRPS), trigeminal neuralgia (TN), and neuropathic pain associated with spinal cord injury. However, further research is needed to enhance our understanding of the optimal use of BTX-A in specific neuralgias. It is important to acknowledge the limitations of the included studies. Nevertheless, BTX-A might be considered a viable treatment option for neuralgia.

When a clinician, especially one who is specialized in primary care is faced with presenting complaints of deep, sharp, anterior chest pain, the most common differential diagnoses include cardiac and gastrointestinal pain. Musculoskeletal pain is thought of less frequently as a possible root cause. In this case report, we describe the clinical journey of a female athlete who presented with complaints of burning anterior chest pain. Her sternalis syndrome pain was first misdiagnosed as pain of cardiac origin, resulting in pacemaker placement into the patient\'s chest. The pain continued, and the same musculoskeletal pain was then presumed to be of gastrointestinal origin due to a previous history of gastroesophageal reflux disease (GERD). As a result of this misidentification, the patient underwent an unnecessary esophageal surgical procedure. Here, we identify the origins of sternalis syndrome pain, what other conditions the pain may be confused with, and how clinicians should not be quick to exclude musculoskeletal pain from a differential diagnosis of acute chest pain. We discuss effective treatments for sternalis syndrome and shed light on this less common cause of anterior chest pain to promote more accurate diagnosis and avoidance of unnecessary surgical interventions.

In recent years, there has been an increase in demand for gluteal augmentation and reshaping surgeries with intramuscular implants which are becoming increasingly popular. Until now, this surgery was mainly performed under general anesthesia, but recently locoregional anesthesia techniques, such as tumescent local anesthesia, are being applied more and more. Today, the use of ultrasound for locoregional anesthesia and analgesia allows us to perform techniques that are increasingly precise and burdened with lower risks. In this report, we present a novel two-step ultrasound-guided technique combining a botox injection in the gluteus maximus four weeks before surgery and tumescent anesthesia with a cluneal nerve block. Furthermore, the combination of anesthetic and analgesic techniques can guarantee a better result both in terms of surgical execution of the intervention and in reducing pain and improving patient comfort in the postoperative period.

The purpose of this study is to establish the efficacy of Yonsei point in the treatment of a gummy smile in a White South African population. The accurate surface anatomy criteria in relation to the underlying musculature for the administration of Botulinum toxin injections in the treatment of gummy smile was determined.
Nineteen (10 males and 9 females) cadavers were selected for facial dissection. Facial profile photographs were taken before and after dissection. The before and after photographs were overlayed to determine where the pin positions should be on the dissected cadaver to determine the Yonsei point. The levator labii superioris (LLS), LLS alaeque nasi (LLSAN), zygomaticus minor, and zygomaticus major muscles were measured using a protractor and ruler, which accounted for the manual measurements. Digital measurements were measured by importing dissected images into ImageJ. Circles with a 2 cm diameter (1 cm radius) were constructed to determine whether the Yonsei point could successfully influence muscles fibers.
Digital and manual measurements show comparable results with high correlation and reliability. Results showed that the White South African population had narrower facial musculature angles as compared with the Korean population.
Based on the selected sample, the Yonsei point is an ineffective injection site for the successful treatment of gummy smile in a White South African population.

Seat belt syndrome (SBS) represents all injury profiles associated with seat belt injuries and motor vehicle crashes (MVCs). Seat belt syndrome classically presents with a superficial seat belt sign that may signify deeper intra-abdominal and/or spinal involvement. The amount of force transmitted from the restraint to the passenger ultimately dictates the amount and severity of the injury. We present a unique case of a 59-year-old female involved in a motor vehicle crash with multiple traumatic injuries, including seat belt syndrome, abdominal wall transection, and bowel injuries. She later had reconstruction of her traumatic abdominal wall hernias (TAWHs). Three unique approaches were used in the management of her traumatic abdominal wall hernias: (1) preoperative Botulinum toxin (Botox) injections, (2) operative use of biologic and bioabsorbable meshes in contaminated fields, and (3) postoperative physical therapy and body positioning. The patient did not experience any recurrence of these hernias after her abdominal wall reconstruction and remains alive at the time this case was written. The diagnostic criteria and surgical management of traumatic abdominal wall hernias have yet to be established, and the case presented here provides approaches that should serve as future areas for study.

Both calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) and OnabotulinumtoxinA (botox) are used in the prevention of chronic migraines. However, it is not clear which is more effective overall. This review will compare the efficacy, side effects, cost-effectiveness, and other factors between CGRP mAbs and botox. We searched Pubmed and Google Scholar using the keywords migraines, CGRP mAbs, botox, efficacy, side effects, aura. All articles, including case-control/cohort studies, case series, case reports, randomized control trials, traditional/systematic reviews, were analyzed. CGRP mAbs and botox both reduce the frequency of migraines in patients. Patients have reported they decreased migraines\' frequency and intensity in several studies after being given each medication. While CGRP mAbs are more recent medications, botox has been studied for more than a decade as a migraine preventative. Both drugs have minor short-term side effects, but some CGRP mAbs may cause persistent constipation too. CGRP mAbs are self-injected every month, and botox is physician-injected every three months, making it easier to stay compliant. While both medications are expensive, botox has a lower cost over time. Botox is more effective prophylaxis of migraines based on the articles that were reviewed. While both CGRP mAbs and botox are efficacious and tolerable, botox has been studied longer, has fewer side effects, is more cost-effective, and is easier to comply with.

Background Sialorrhea is a common comorbidity among children with neurologic disorders. Botulinum toxin injections and surgical procedures are recommended for the management of pathological sialorrhea in patients who fail conservative management or with concerns for salivary aspiration. The following review evaluates outcomes following botulinum toxin injections and surgical interventions for sialorrhea over a 10-year period with a focus on treatment options and outcomes for patients with anterior and posterior drooling. Methods The study included all patients less than 25 years of age who underwent a procedure for drooling (Current Procedural Terminology (CPT) codes 42440, 42450, 42509, 42510, 64611 matched with the International Classification of Diseases (ICD)-9 and ICD-10 codes 527.7 and K11.7) from January 1, 2006 to December 31, 2015. A chart review collected demographics, drooling medication use, and type of drooling (anterior, posterior, both). Outcome variables included pre- and post-procedure number of bibs, parent-reported outcomes, post-intervention drooling medication requirement, post-procedure length of stay, and complications. Results Seventy-one patients were included in our analysis, with 88 total procedures performed. The average age at first intervention was 8.9 years; 43 patients were male and 40 patients had cerebral palsy. Thirty-one patients experienced posterior drooling or anterior/posterior drooling. These patients were more likely to undergo surgery as the first invasive intervention. The most commonly performed interventions were botulinum toxin injections (28 patients, 39%) and sublingual gland excision (SLGE) with submandibular duct ligation (SMDL) (36 patients, 51%). Improvement following injections was noted in 56% of patients versus 73% of patients following any surgical intervention. Conclusion Management of drooling is complex with 18 different procedures performed over 10 years. Surgical interventions, specifically SLGE with SMDL and submandibular gland excision (SMGE), result in substantial improvement; these are commonly performed as the first intervention in patients with posterior drooling. By reviewing our experience, we hope to guide management decisions and help manage patient and caregiver expectations.