{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T13:41:55Z","timestamp":1777642915250,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2015,5,1]],"date-time":"2015-05-01T00:00:00Z","timestamp":1430438400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["JAMA Facial Plast Surg"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Botulinum toxin A has been described as an effective adjunct treatment for achieving symmetry in adults with facial paralysis. Few investigators have described the use of botulinum toxin A in pediatric patients with facial paralysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To present our preliminary experience with botulinum toxin A in pediatric patients presenting with asymmetry of the lower lip.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>We performed a retrospective medical record review of all pediatric patients (age range, 4-17 years; mean [SD] age, 11.2 [4.7] years) with facial paralysis who were treated with botulinum toxin A injections from January 1, 2004, through December 31, 2012. Patients presented for treatment at The Hospital for Sick Children, Toronto, Ontario, Canada, or the Massachusetts Eye and Ear Infirmary, Boston.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Using facial analysis software, we measured lower lip asymmetry in the patients\u2019 photographs before and after treatment, at rest, and in a dynamic state. We performed analysis of variance to assess for improvement in symmetry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 18 patients with the following 3 primary indications for treatment: focal lip asymmetry (n\u2009=\u200911), extensive hemifacial asymmetry (n\u2009=\u20095), and focal synkinesis (n\u2009=\u20092). We found no complications related to botulinum toxin A treatment. The mean (SD) dynamic deviation before the injection was 3.5 (1.7) mm, whereas the mean dynamic deviation after the injection was 1.5 (0.8) mm. The mean (SD) deviation correction was evaluated at 61% (6%) and was statistically significant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Botulinum toxin A injection is a safe procedure for improving localized asymmetry in pediatric patients with facial paralysis. Preliminary results indicate that botulinum toxin A may be an effective treatment for lower lip asymmetry in children and adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/archfaci.jamanetwork.com\/public\/instructionsForAuthors.aspx#SecLevelofEvidence\">4<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamafacial.2015.10","type":"journal-article","created":{"date-parts":[[2015,3,5]],"date-time":"2015-03-05T12:30:57Z","timestamp":1425558657000},"page":"174-178","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["The Role of Botulinum Toxin A in the Establishment of Symmetry in Pediatric Paralysis of the Lower Lip"],"prefix":"10.1177","volume":"17","author":[{"given":"Siba","family":"Haykal","sequence":"first","affiliation":[{"name":"Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ehud","family":"Arad","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaghayegh","family":"Bagher","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn","family":"Lai","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Hohman","sequence":"additional","affiliation":[{"name":"Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Boston"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tessa","family":"Hadlock","sequence":"additional","affiliation":[{"name":"Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Boston"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald M.","family":"Zuker","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory H.","family":"Borschel","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2015,5,21]]},"reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200005000-00001"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2004.04.003"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000264062.64251.10"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1996.tb01018.x"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000169689.27829.C4"},{"issue":"11","key":"e_1_3_1_7_2","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1038\/eye.2012.189","article-title":"Botulinum toxin to improve lower facial symmetry in facial nerve palsy.","volume":"73","author":"Sadiq S","year":"2012","unstructured":"Sadiq S, , Khwaja S, , Saeed S. 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