Treatment of Primary Craniofacial XXXX : A Systematic Review.

@entity2122 @entity1 @entity1119 @entity3190 @entity11440
BACKGROUND: Primary @entity2122 ( @entity2122 ) can have a profoundly negative impact on quality of life. No comprehensive review of its management exists. OBJECTIVE: The objective of this review is to present the best clinical evidence to guide @entity2122 management. METHODS: A systematic review was performed using PRISMA guidelines. MEDLINE and EMBASE were searched from 1966 to 2014 for articles using the MeSH terms " @entity1119 ", "Head", "Neck" and synonymous text words. Inclusion criteria were experimental and observational studies addressing @entity2122 treatment. Two reviewers independently assessed study quality and analysed data. RESULTS: Of 833 references yielded, 27 met inclusion criteria and were analysed. Twenty-two studies evaluated T2 sympathetic ablation (Level III evidence). Outcome measures were subjective and mean follow-up was 29  months. Reported efficacy was high (70-100  %), recurrence rates were generally low (0-8  %) and complications largely transient (e.g. pneumothorax 0-1  %). However, 8-95.4  % experienced troubling @entity3190 . One randomised controlled trial and one observational study evaluated botulinum toxin A (Level Ib and III, respectively). Both employed objective outcome measures and demonstrated similar findings. Efficacy was 100  %, lasted a median of 5-6  months and frontalis muscle inhibition was the main adverse effect (50-100  %). Three studies evaluated anticholinergic therapy: topical glycopyrrolate demonstrated high efficacy (96  %) with minimal adverse effects (Level Ib) and oral @entity11440 demonstrated relatively high efficacy (80-100  %) but with noticeable adverse effects (76.6-83.6  %) (Level III). CONCLUSION: There are few quality studies evaluating @entity2122 treatment. Based on available evidence, we recommend topical glycopyrrolate, oral @entity11440 and intradermal botulinum toxin A as first-line therapies due to their efficacy and safety. T2 sympathectomy should be considered for @entity1 refractory to first-line therapy.
