Burning Mouth Syndrome – Remarkable Improvement with Botulinum Injections

“16 units of incobotulinumtoxinA (100 units diluted in 2 mL of saline), 4 units into each side of the lower lip and 4 units into each anterolateral side of the tongue” – “The beneficial effects lasted up to 16 weeks after injection in all but 1 patient, in whom they lasted up to 20 weeks.”

Ann Intern Med. 2017 Apr 11. doi: 10.7326/L16-0451. [Epub ahead of print]
Botulinum Toxin for Burning Mouth Syndrome.
Restivo DA, Lauria G, Marchese-Ragona R, Vigneri R.
(no abstract)

  • 4 patients (3 women and 1 man)
  • 67 to 76 years,
  • 3¬† had diabetes
  • burning in¬†anterior two thirds of the tongue and the lower lip
  • incobotulinumtoxinA¬† (Xeomin – using more of – does not need refrigeration and bit cheaper) 100 units in 2 mls
  • 4 units into each side of the lower lip and 4 units into each anterolateral side of the tongue
  • all better for 16-20 weeks

technique: – I’ve included pics because this info is just too important:

Comment – I’m sold- can’t be much simpler to treat than that


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3 Responses to Burning Mouth Syndrome – Remarkable Improvement with Botulinum Injections

  1. Pingback: Refractory Burning Mouth – Try Clonazepam and Venlafaxine | Pain Medical Musing

  2. graham yates says:

    Hi I have a patient with a 10+ year history of refractory burning mouth. Thinks started after whiplash. Very sore over low cervicals and 1st rib area and passive stretch to neck increases mouth symptoms. Any ideas of link?.
    Two things come to mind:
    1) There is a syndrome called the neck – tongue syndrome which can be related to the upper cervical joints and tongue:
    J Rheumatol. 1984 Aug;11(4):530-3. The neck-tongue syndrome: occurrence with cervical arthritis as well as normals. Webb J, March L, Tyndall
    One of the features of upper cervical nerve involvement is the occipital nerves. They will give tenderness of scalp where skull meets neck. They can refer pains down to trigger points in neck and shoulder especially if there is headaches with the occipital pains.
    2) In the lower neck anterolaterally is the stellate ganglion – which is part of the sympathetic nervous system
    Blocking that totally relieved burning tongue half the time and helped most:
    ZHOU Xian-lue,TANG Yi,XU Jin,MEI Zhu-sheng,YANG Zong-zhen.Adopting stellate ganglion block to treat refractoriness burning mouth syndrome.[J];Journal of Clinical Stomatology;2008-08

    Good luck finding an anesthetist who will do stellate blocks though. Accidentally getting IV freezing into a neck vein can cause a seizure and drawing back on syringe to see if there is blood is only accurate half the time.

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