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Anatomical guide for botulinum neurotoxin injection: Application to cosmetic shoulder contouring, pain syndromes, and cervical dystonia

 Kyu-Ho Yi  ;  Hyung-Jin Lee  ;  You-Jin Choi  ;  Kangwoo Lee  ;  Ji-Hyun Lee  ;  Hee-Jin Kim 
 CLINICAL ANATOMY, Vol.34(6) : 822-828, 2021-09 
Journal Title
Issue Date
botulinum neurotoxin ; cervical dystonia ; clinical guideline ; cosmetic shoulder ; shoulder contour ; trapezius muscle
Introduction: This study proposes an ideal botulinum toxin injection point of the trapezius muscle for shoulder line contouring, pain management, and functional impairment. This study describes the intramuscular nerve branching in the trapezius muscle, providing essential information for botulinum neurotoxin injection.

Method: A modified Sihler's method was performed on the trapezius muscles (16 specimens). The intramuscular arborization areas were elucidated regarding the external occipital protuberance superiorly, spinous process of the 12th thoracic vertebra inferiorly and acromion of the scapula.

Result: The intramuscular neural distribution for the superior, middle, and inferior regions of the trapezius muscle had the greatest arborized patterns in the horizontal 1/5-2/5 and vertical 2/10-4/10 sections, the horizontal 1/5-3/5 and vertical 4/10-5/10 sections, and the horizontal 1/5-2/5 and vertical 5/10-7/10 sections, respectively.

Discussion: We propose that BoNT treatments should be directed to the horizontal 1/5-2/5 and vertical 2/10-4/10 sections of the superior trapezius, the horizontal 1/5-3/5 and vertical 4/10-5/10 sections of the middle trapezius and the horizontal 1/5-2/5 and vertical 5/10-7/10 sections of the inferior trapezius. Additionally, injective treatment at the horizontal 2/5-3/5 and vertical 2/10-4/10 nerve entry points should be avoided to prevent nerve trunk damage causing paralysis. According to our guidelines, clinicians can ensure minimal dose injections and fewer adverse effects in botulinum neurotoxin injective treatment.
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2. College of Dentistry (치과대학) > Dept. of Oral Biology (구강생물학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Others (기타) > 1. Journal Papers
Yonsei Authors
Kim, Hee Jin(김희진) ORCID logo https://orcid.org/0000-0002-1139-6261
Lee, Kang Woo(이강우)
Lee, Ji-Hyun(이지현) ORCID logo https://orcid.org/0000-0003-3732-2698
Lee, Hyung Jin(이형진) ORCID logo https://orcid.org/0000-0002-3082-935X
Choi, You Jin(최유진) ORCID logo https://orcid.org/0000-0003-3701-2200
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