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The Anatomical Basis of Paradoxical Masseteric Bulging after Botulinum Neurotoxin Type A Injection

 Hyung-Jin Lee  ;  In-Won Kang  ;  Kyle K. Seo  ;  You-Jin Choi  ;  Seong-Taek Kim  ;  Kyung-Seok Hu  ;  Hee-Jin Kim 
 Toxins, Vol.9(1) : E14, 2017 
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Issue Date
Aged ; Asian Continental Ancestry Group ; Botulinum Toxins, Type A/therapeutic use* ; Facial Hemiatrophy/drug therapy ; Humans ; Injections ; Masseter Muscle/anatomy & histology* ; Masseter Muscle/drug effects* ; Neuromuscular Agents/therapeutic use* ; Republic of Korea ; Tendons/anatomy & histology* ; Tendons/drug effects* ; Thailand
botulinum neurotoxin Type A injection ; lower facial contour ; paradoxical masseteric bulging ; superficial part of masseter muscle
The aim of this study was to determine the detailed anatomical structures of the superficial part of the masseter and to elucidate the boundaries and locations of the deep tendon structure within the superficial part of the masseter. Forty-four hemifaces from Korean and Thai embalmed cadavers were used in this study. The deep tendon structure was located deep in the lower third of the superficial part of the masseter. It was observed in all specimens and was designated as a deep inferior tendon (DIT). The relationship between the masseter and DIT could be classified into three types according to the coverage pattern: Type A, in which areas IV and V were covered by the DIT (27%, 12/44); Type B, in which areas V and VI were covered by the DIT (23%, 10/44); and Type C, in which areas IV, V, and VI were covered by the DIT (50%, 22/44). The superficial part of the masseter consists of not only the muscle belly but also the deep tendon structure. Based on the results obtained in this morphological study, we recommend performing layer-by-layer retrograde injections into the superficial and deep muscle bellies of the masseter.
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2. College of Dentistry (치과대학) > Dept. of Orofacial Pain and Oral Medicine (구강내과학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Oral Biology (구강생물학교실) > 1. Journal Papers
Yonsei Authors
김성택(Kim, Seong Taek)
김희진(Kim, Hee Jin) ORCID logo https://orcid.org/0000-0002-1139-6261
이형진(Lee, Hyung Jin) ORCID logo https://orcid.org/0000-0002-3082-935X
최유진(Choi, You Jin) ORCID logo https://orcid.org/0000-0003-3701-2200
허경석(Hu, Kyung Seok) ORCID logo https://orcid.org/0000-0002-9048-3805
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