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Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin

 Woo-Sang Hwang  ;  Mi-Sun Hur  ;  Kyung-Seok Hu  ;  Wu-Chul Song  ;  Ki-Seok Koh  ;  Hyoung-Seon Baik  ;  Seong-Taek Kim  ;  Hee-Jin Kim  ;  Kee-Joon Lee 
 ANGLE ORTHODONTIST, Vol.79(1) : 70-77, 2009 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Botulinum Toxins, Type A/administration & dosage* ; Cadaver ; Facial Muscles/anatomy & histology* ; Facial Muscles/drug effects ; Female ; Gingival Diseases/therapy* ; Humans ; Injections, Intramuscular ; Lip/anatomy & histology* ; Lip/drug effects ; Male ; Middle Aged ; Muscle Contraction/drug effects ; Neuromuscular Agents/administration & dosage* ; Smiling
Injection point ; Botulinum toxin ; Lip elevator muscles ; Gummy smile
OBJECTIVE: To propose a safe and reproducible injection point for botulinum toxin-A (BTX-A) as a supplementary method for the treatment of gummy smile, as determined by assessment of the morphologic characteristics of three lip elevator muscles.

MATERIALS AND METHODS: A total of 50 hemi-faces from 25 adult cadavers (male 13, female 12; ages, 47 to 88 years) were used in this study. Topographic relations and the directions of the lip elevator muscles (ie, levator labii superioris [LLS], levator labii superioris alaeque nasi [LLSAN], and zygomaticus minor [ZMi]), were investigated. Possible injection points were examined through the study of predetermined surface landmarks.

RESULTS: The insertion of the LLS was covered partially or entirely by the LLSAN and the ZMi, and the three muscles converged on the area lateral to the ala. The mean angle between the facial midline and each muscle vector was 25.8 +/- 4.8 degrees for the LLS, 55.7 +/- 6.4 degrees for the ZMi, and -20.2 +/- 3.2 degrees for the LLSAN; no significant differences were noted between male and female subjects or between left and right sides. The three vectors passed near a triangular region formed by three surface landmarks. The center of this triangle, named the "Yonsei point", was suggested as an appropriate injection point for BTX-A. The clinical effectiveness of the injection point was demonstrated in selected cases with or without orthodontic treatment.

CONCLUSIONS: Under careful case selection, BTX-A may be an effective treatment alternative for patients with excessive gingival display caused by hyperactive lip elevator muscles.
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Appears in Collections:
2. College of Dentistry (치과대학) > Dept. of Oral Biology (구강생물학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Orofacial Pain and Oral Medicine (구강내과학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Orthodontics (교정과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seong Taek(김성택)
Kim, Hee Jin(김희진) ORCID logo https://orcid.org/0000-0002-1139-6261
Baik, Hyoung Seon(백형선)
Lee, Kee Joon(이기준) ORCID logo https://orcid.org/0000-0002-0782-3128
Hu, Kyung Seok(허경석) ORCID logo https://orcid.org/0000-0002-9048-3805
Hur, Mi Sun(허미선)
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