Botulinum toxin as a therapeutic adjunct in the management of facial fractures and osteotomies: case series and systematic review of an innovative chemical fixation approach.

In the field of maxillofacial surgery, facial bone fractures and osteotomies are common but the management of these conditions is associated with complications, including displacement after fracture or relapse after orthognathic surgery. Botulinum toxin, a therapeutic agent that temporarily paralyzes the injected muscle, has several indications in the orofacial region. This study presents a case series and a systematic review of the literature regarding the use of botulinum toxin in masticatory muscles for the management of facial bone fractures and osteotomies. Three cases were reported and a systematic review was reported according to the PRISMA guidelines, focusing on the following research questions: "How does botulinum toxin affect bone displacement after osteotomy or fracture?". The MEDLINE/PubMed, Web of Science, and Embase databases were searched using the following keywords: "botulinum toxin" AND ["fracture" OR "osteotomy" OR "bone healing"]. A total of 837 articles were initially identified. Based on the selection criteria, 8 studies were included. The review and case series showed that botulinum toxin could improve the fixation of facial bone fractures and osteotomies. Masticatory muscles generate significant tensile forces through their bony insertions. Intra-muscular botulinum toxin injections can be used to counteract this tension, thereby decreasing muscle function and improving surgical outcomes.