Application of botulinum toxin type A in the rehabilitation of patients after orthognathic surgery. (Literature review)

Objective. To analyze current evidence on the use of botulinum toxin type A (BoNT-A) for optimizing neuromuscular adaptation and preventing complications after orthognathic surgery. Materials and methods. A literature search was conducted in PubMed, Scopus, and Elibrary (2017—2026). Randomized controlled trials, systematic reviews, and meta-analyses on BoNT-A effects on masticatory muscles in the maxillofacial area were included. Results. Direct clinical evidence is limited: Shin (2018) RCT showed that BoNT-A injection into the masseter muscles reduced plate fracture rate (2/16 vs. 8/16, p=0.031). Ban (2023) reported stable occlusion at 9 months after BoNT-A into the anterior belly of the digastric muscle (n=5). Systematic reviews confirm reversible masticatory muscle atrophy, decreased bite force, and EMG activity. Safety profile is favorable, with transient local adverse effects. A marked placebo effect has been demonstrated. Conclusion. BoNT-A may effectively reduce loading on osteosynthesis sites and prevent relapse, but existing studies have small sample sizes, short follow-up, and lack standardization. Large placebo-controlled trials with long-term follow-up are needed.