Tag Archives: botox

General Surgery, Print Release

PUBLISHED: Anal Examination Under Anesthesia and Botox Injection for Chronic Anal Fissures

Anal Examination Under Anesthesia and Botox Injection for Chronic Anal Fissures
Jennifer Shearer, MD; Brooke Gurland, MD, FACS
Stanford University School of Medicine

Most individuals associate anal pain with hemorrhoids. However, there are many conditions that can cause anal pain and bleeding, and physical examination helps to differentiate between these diagnoses: anal fissures, hemorrhoids, or infections.

An anal fissure is a superficial tear in the anoderm. Fissures are diagnosed clinically by history and physical exam with careful spreading of the anus and direct visualization of a break in the mucosa and exposed sphincter fibers. Increased tone of the internal anal sphincter can inhibit fissure healing by decreasing blood flow to the mucosa.

Conservative management includes stool softeners and warm sitz baths to avoid traumatizing the fissure with hard stools and relaxing the sphincters with warm water. Topical nitrates or calcium channel blockers applied at the anal verge dilate and relax the internal sphincter muscle to promote healing.

Alternatively, injection of Onobotulinumtoxin A into the fissure and intersphincteric groove paralyzes sphincter muscle, decreasing muscle spasm and supporting healing of the fissure. For individuals who fail these conservative therapies, lateral internal sphincterotomy is considered. This procedure involves dividing the internal sphincter muscles but carries a small risk of fecal incontinence.

This video article presents the case of a young adult male with a history of a chronic anal fissure, who failed medical management. Anal fissure was appreciated on exam and treated with Onobotulinumtoxin A injection for relaxation of anal sphincter.

Otolaryngology, Print Release

PUBLISHED: Botox Injection

Botox Injection
Charles R. Woodard, MD¹; Alexandra L. Elder, BS²; Helen A. Moses, MD¹; C. Scott Brown, MD¹
¹Duke University Medical Center
²Thomas Jefferson University

Botox injection is one of the most common cosmetic procedures performed. Botox temporarily paralyzes targeted skeletal muscles of the face, reducing the patient’s ability to produce unwanted dynamic wrinkles. Commonly treated areas of the face include the procerus and corrugator supercilii muscles to treat glabellar frown lines, the frontalis muscle to treat horizontal rhytids of the forehead, and the orbicularis oculi muscle to treat “crow’s feet” wrinkles along the lateral aspect of the orbit.

A thorough facial analysis is necessary to develop a treatment plan for each problem area, particularly by engaging the patient to determine what his or her goals for treatment are. Providers must take care when injecting into the face to avoid complications of overtreatment, such as brow ptosis from over-injecting the forehead or elevated brow from over-injecting the periorbital muscles.

Otolaryngology, Preprint Release

PREPRINT RELEASE: Botox Injection

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Botox Injection
Duke University Medical Center
Charles R. Woodard MD
C. Scott Brown MD
Helen A. Moses MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences

Facial plastics surgeon Charles Woodard, MD instructs his residents on the principles of facial analysis. He then demonstrates the proper technique for administration of Botox during an injection workshop. While typically associated with facial wrinkles, Botox may also be used to help treat blepharospasm as well as migraine headaches.