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Accessory nerve distribution for aesthetic botulinum toxin injections into the upper trapezius muscle: anatomical study and clinical trial : Reproducible BoNT injection sites for upper trapezius

 Jung-Hee Bae  ;  Ji-Soo Lee  ;  Da-Yae Choi  ;  JeongHoon Suhk  ;  Seong Taek Kim 
 Surgical and Radiologic Anatomy, Vol.40(11) : 1253-1259, 2018 
Journal Title
 Surgical and Radiologic Anatomy 
Issue Date
Accessory Nerve/anatomy & histology* ; Accessory Nerve/diagnostic imaging ; Aged ; Aged, 80 and over ; Botulinum Toxins/administration & dosage* ; Cadaver ; Esthetics ; Female ; Humans ; Injections ; Male ; Neck Dissection ; Reproducibility of Results ; Superficial Back Muscles/diagnostic imaging ; Superficial Back Muscles/innervation*
Accessory nerve ; Botulinum toxin ; Injection point ; The descending part of trapezius
PURPOSE: The descending part of the trapezius muscle is clinically associated with neck pain and aesthetic applications. The innervation of the trapezius muscle is not well described in the medical literature for clinicians. The aim of study was to analyze the perforating branch pattern of the accessory nerve in the descending part of the trapezius muscle with the aim of describing the most efficient and reproducible BoNT injection sites for aesthetic treatment of shoulder contouring. METHODS: Twenty-six specimens (five male and eight female) from embalmed Korean cadavers were used in this study. The trapezius muscle was dissected scrupulously and then reflected to enable examination of the locations of the perforating points. The thickness of trapezius muscle was measured in 13 volunteers using a diagnostic ultrasonography system. BoNT was injected into the trapezius muscle bilaterally. Injections were performed at 6 points separated by 2 cm. The muscle thicknesses were measured three times using ultrasonography: before the injection and at 4 and 12 weeks after the injection. RESULTS: The dense arborization of the perforating accessory nerve branches was confined mostly to section b (66.7%, 54/81) and section c (33.3%, 27/81). The mean muscle thickness at 4 and 12 weeks consistently decreased 0.68-0.63 cm in conventional method and 0.65-0.61 cm in new method (NDM) respectively (right and left). CONCLUSION: To optimize the outcome of BoNT injection, we recommended injecting into six points separated by 2 cm in sections b and c of the upper trapezius muscle. It is significant that it is easier to apply to anyone than to apply unstructured techniques.
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2. College of Dentistry (치과대학) > Dept. of Orofacial Pain and Oral Medicine (구강내과학교실) > 1. Journal Papers
Yonsei Authors
김성택(Kim, Seong Taek)
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