1333 - Management of Severe Bruxism in Anoxic Brain Injury with Botulinum Toxin A in the ICU: A Case Report

A 19-year-old primiparous female at 37 weeks gestation was diagnosed with acute fatty liver of pregnancy and viral hepatitis. Following induced labor, she experienced two PEA arrests, requiring VA-ECMO for five days, resulting in severe neurologic damage and a vegetative state. MRI showed hypoxic brain injury, subarachnoid hemorrhage, and temporomandibular joint degeneration. By day 23 post-arrest, she developed severe bruxism causing a 1x1.5 cm tongue injury by day 43. She required frequent suctioning for blood pooling in her mouth. 

Trials of propranolol (20 mg BID) and diazepam (5 mg daily) were ineffective. On day 45, while the patient was in the ICU, 200 units of BTX-A were injected into the bilateral temporalis and masseter muscles (50 units each muscle). By day 4 post-injection, suctioning needs decreased, and by day 12, bruxism intensity was significantly reduced, allowing intermittent volitional mouth movements. 






Discussions: Bruxism in anoxic brain injury patients poses therapeutic challenges. Traditional treatments often fall short, while BTX-A shows promise by reducing bruxism frequency and pain through muscle inhibition. However, BTX-A's use in acute neurologic settings is less documented. This case demonstrates BTX-A's potential in effectively reducing bruxism in a patient with anoxic brain injury in the ICU. 

Conclusions: This case highlights the safety and efficacy of BTX-A for treating severe bruxism in a patient with anoxic brain injury in the ICU, and its potential to prevent further oral injuries when traditional methods prove inadequate.