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Toxins 2017, 9(1), 14; doi:10.3390/toxins9010014

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

1
Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul 03722, Korea
2
Modelo Clinic, Seoul 06011, Korea
3
Department of Oral Medicine, TMJ and Orofacial Pain Clinic, Yonsei University College of Dentistry, Seoul 03722, Korea
4
Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonseiro, Seodaemun-gu, Seoul 03722, Korea
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Academic Editor: Bahman Jabbari
Received: 16 November 2016 / Revised: 26 December 2016 / Accepted: 26 December 2016 / Published: 30 December 2016
(This article belongs to the Collection Botulinum Toxins on Human Pain)
View Full-Text   |   Download PDF [5182 KB, uploaded 30 December 2016]   |  

Abstract

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. View Full-Text
Keywords: superficial part of masseter muscle; paradoxical masseteric bulging; botulinum neurotoxin Type A injection; lower facial contour superficial part of masseter muscle; paradoxical masseteric bulging; botulinum neurotoxin Type A injection; lower facial contour
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Lee, H.-J.; Kang, I.-W.; Seo, K.K.; Choi, Y.-J.; Kim, S.-T.; Hu, K.-S.; Kim, H.-J. The Anatomical Basis of Paradoxical Masseteric Bulging after Botulinum Neurotoxin Type A Injection. Toxins 2017, 9, 14.

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