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Open AccessArticle

Ultrasonographic Considerations for Safe and Efficient Botulinum Neurotoxin Injection in Masseteric Hypertrophy

by 1,†, 1,†, 2 and 1,3,*
1
Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul 03722, Korea
2
Department of Orofacial Pain & Oral Medicine, Yonsei University College of Dentistry, Seoul 03722, Korea
3
Department of Materials Science & Engineering, Yonsei University College of Engineering, Seoul 03722, Korea
*
Author to whom correspondence should be addressed.
The first two authors contributed equally to this work.
Toxins 2021, 13(1), 28; https://doi.org/10.3390/toxins13010028
Received: 5 October 2020 / Revised: 28 December 2020 / Accepted: 30 December 2020 / Published: 4 January 2021
(This article belongs to the Special Issue Application of Botulinum Toxin in Clinical Medicine)
There are still concerns about masseteric bulging due to a lack of knowledge about the internal architecture of the masseter muscle. Further investigations are therefore required of the most-effective botulinum neurotoxin (BoNT) injection points and strategies for managing masseteric bulging. The purpose of this study was to identify safer and more effective botulinum neurotoxin injection points and strategies by using ultrasonography to determine the structural patterns of the deep inferior tendon. We also measured the precise depths and locations of the deep inferior tendon of the masseter muscle. Thirty-two healthy volunteers participated in this study, and ultrasonography was used to scan the masseter muscle both longitudinally and transversely. Three structural patterns of the deep inferior tendon were identified: in type A, the deep inferior tendon covered the anterior two-thirds of the masseter muscle (21.8%); in type B, the deep inferior tendon covered the posterior two-thirds of the masseter muscle (9.4%); and in type C, the deep inferior tendon covered most of the inferior part of the masseter muscle (68.8%). Depending on the ultrasonography scanning site, the depth from the skin surface to the mandible in the masseteric region ranged from 15 to 25 mm. The deep inferior tendon was typically located 2 to 5 mm deep from the mandible. Ultrasonography can be used to observe the internal structure of the masseter muscle including the deep inferior tendon in individual patients. This will help to reduce the side effects of masseteric bulging when applying retrograde or dual-plane injection methods depending on the structural pattern of the deep inferior tendon. View Full-Text
Keywords: ultrasonography; botulinum neurotoxin injection; masseter muscle; masseteric hypertrophy; clinical guideline ultrasonography; botulinum neurotoxin injection; masseter muscle; masseteric hypertrophy; clinical guideline
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MDPI and ACS Style

Lee, H.-J.; Jung, S.-J.; Kim, S.-T.; Kim, H.-J. Ultrasonographic Considerations for Safe and Efficient Botulinum Neurotoxin Injection in Masseteric Hypertrophy. Toxins 2021, 13, 28. https://doi.org/10.3390/toxins13010028

AMA Style

Lee H-J, Jung S-J, Kim S-T, Kim H-J. Ultrasonographic Considerations for Safe and Efficient Botulinum Neurotoxin Injection in Masseteric Hypertrophy. Toxins. 2021; 13(1):28. https://doi.org/10.3390/toxins13010028

Chicago/Turabian Style

Lee, Hyung-Jin; Jung, Su-Jin; Kim, Seong-Taek; Kim, Hee-Jin. 2021. "Ultrasonographic Considerations for Safe and Efficient Botulinum Neurotoxin Injection in Masseteric Hypertrophy" Toxins 13, no. 1: 28. https://doi.org/10.3390/toxins13010028

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