Anatomy and Cell Biology

Korean Association of Anatomists (대한해부학회)
권호 표지
DOI QR코드

DOI QR Code

Novel anatomical guidelines for botulinum neurotoxin injection in the mentalis muscle: a review

  • Kyu-Ho Yi (Wonju Public Health Center) ;
  • Ji-Hyun Lee (Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University) ;
  • Hye-Won Hu (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry) ;
  • Hyun-Jun Park (Maylin Anti-Aging Center Apgujeong) ;
  • Hyungkyu Bae (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry) ;
  • Kangwoo Lee (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry) ;
  • Hee-Jin Kim (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry)
  • Received : 2022.12.22
  • Accepted : 2023.01.25
  • Published : 2023.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

The mentalis muscle is a paired muscle originating from the alveolar bone of the mandible. This muscle is the main target muscle for botulinum neurotoxin (BoNT) injection therapy, which aims to treat cobblestone chin caused by mentalis hyperactivity. However, a lack of knowledge on the anatomy of the mentalis muscle and the properties of BoNT can lead to side effects, such as mouth closure insufficiency and smile asymmetry due to ptosis of the lower lip after BoNT injection procedures. Therefore, we have reviewed the anatomical properties associated with BoNT injection into the mentalis muscle. An up-to-date understanding of the localization of the BoNT injection point according to mandibular anatomy leads to better injection localization into the mentalis muscle. Optimal injection sites have been provided for the mentalis muscle and a proper injection technique has been described. We have suggested optimal injection sites based on the external anatomical landmarks of the mandible. The aim of these guidelines is to maximize the effects of BoNT therapy by minimizing the deleterious effects, which can be very useful in clinical settings.

Keywords

Acknowledgement

This study was conducted in compliance with the Declaration of Helsinki. Consent was received from the families of the deceased patients before beginning the dissection. The authors sincerely thank those who donated their bodies to science for anatomical research. The results of such research can aid in mankind's overall knowledge, which can improve patient care. Therefore, these donors and their families deserve the greatest gratitude.

References

  1. Dessy LA, Mazzocchi M, Rubino C, Mazzarello V, Spissu N, Scuderi N. An objective assessment of botulinum toxin A effect on superficial skin texture. Ann Plast Surg 2007;58:469-73. 
  2. Childers MK. Targeting the neuromuscular junction in skeletal muscles. Am J Phys Med Rehabil 2004;83(10 Suppl):S38-44. 
  3. Choi DY, Bae H, Bae JH, Kim HJ, Hu KS. Effective locations for injecting botulinum toxin into the mentalis muscle; cadaveric and ultrasonographic study. Toxins (Basel) 2021;13:96. 
  4. Hsu TS, Dover JS, Arndt KA. Effect of volume and concentration on the diffusion of botulinum exotoxin A. Arch Dermatol 2004;140:1351-4. 
  5. Kinnett D. Botulinum toxin A injections in children: technique and dosing issues. Am J Phys Med Rehabil 2004;83(10 Suppl):S59-64. 
  6. Lepage D, Parratte B, Tatu L, Vuiller F, Monnier G. Extra-and intramuscular nerve supply of the muscles of the anterior antebrachial compartment: applications for selective neurotomy and for botulinum toxin injection. Surg Radiol Anat 2005;27:420-30. 
  7. Pingel J, Nielsen MS, Lauridsen T, Rix K, Bech M, Alkjaer T, Andersen IT, Nielsen JB, Feidenhansl R. Injection of high dose botulinum-toxin A leads to impaired skeletal muscle function and damage of the fibrilar and non-fibrilar structures. Sci Rep 2017;7:14746. 
  8. Yi KH, Choi YJ, Cong L, Lee KL, Hu KS, Kim HJ. Effective botulinum toxin injection guide for treatment of cervical dystonia. Clin Anat 2020;33:192-8. 
  9. Yi KH, Cong L, Bae JH, Park ES, Rha DW, Kim HJ. Neuromuscular structure of the tibialis anterior muscle for functional electrical stimulation. Surg Radiol Anat 2017;39:77-83. 
  10. Yi KH, Rha DW, Lee SC, Cong L, Lee HJ, Lee YW, Kim HJ, Hu KS. Intramuscular nerve distribution pattern of ankle invertor muscles in human cadaver using sihler stain. Muscle Nerve 2016;53:742-7. 
  11. Rha DW, Yi KH, Park ES, Park C, Kim HJ. Intramuscular nerve distribution of the hamstring muscles: application to treating spasticity. Clin Anat 2016;29:746-51. 
  12. Yi KH, Lee HJ, Lee JH, Lee KL, Kim HJ. Effective botulinum neurotoxin injection in treating iliopsoas spasticity. Clin Anat 2021;34:431-6. 
  13. Yi KH, Lee HJ, Choi YJ, Lee K, Lee JH, Kim HJ. Anatomical guide for botulinum neurotoxin injection: application to cosmetic shoulder contouring, pain syndromes, and cervical dystonia. Clin Anat 2021;34:822-8. 
  14. Yi KH, Lee KL, Lee JH, Hu HW, Lee K, Seo KK, Kim HJ. Guidelines for botulinum neurotoxin injections in piriformis syndrome. Clin Anat 2021;34:1028-34. 
  15. Yi KH, Lee HJ, Lee JH, Seo KK, Kim HJ. Application of botulinum neurotoxin injections in TRAM flap for breast reconstruction: intramuscular neural arborization of the rectus abdominis muscle. Toxins (Basel) 2021;13:269. 
  16. Yi KH, Lee JH, Lee DK, Hu HW, Seo KK, Kim HJ. Anatomical locations of the motor endplates of sartorius muscle for botulinum toxin injections in treatment of muscle spasticity. Surg Radiol Anat 2021;43:2025-30. 
  17. Yi KH, Lee HJ, Seo KK, Kim HJ. Botulinum neurotoxin injection guidelines regarding flap surgeries in breast reconstruction. J Plast Reconstr Aesthet Surg 2022;75:503-5. 
  18. Yi KH, Lee JH, Hu HW, Kim HJ. Novel anatomical guidelines on botulinum neurotoxin injection for wrinkles in the nose region. Toxins (Basel) 2022;14:342. 
  19. Yi KH, Lee JH, Kim HJ. Intramuscular neural distribution of the serratus anterior muscle: regarding botulinum neurotoxin injection for treating myofascial pain syndrome. Toxins (Basel) 2022;14:271. 
  20. Yi KH, Lee JH, Hu HW, Kim HJ. Anatomical proposal for botulinum neurotoxin injection for glabellar frown lines. Toxins (Basel) 2022;14:268. 
  21. Yi KH, Lee HJ, Seo KK, Kim HJ. Intramuscular neural arborization of the latissimus dorsi muscle: application of botulinum neurotoxin injection in flap reconstruction. Toxins (Basel) 2022;14:107. 
  22. Lee HJ, Lee JH, Yi KH, Kim HJ. Sonoanatomy and an ultrasound scanning protocol of the intramuscular innervation pattern of the infraspinatus muscle. Reg Anesth Pain Med 2022 Nov 25 [Epub]. https://doi.org/10.1136/rapm-2022-103682 
  23. Lee HJ, Lee JH, Yi KH, Kim HJ. Intramuscular innervation of the supraspinatus muscle assessed using Sihler's staining: potential application in myofascial pain syndrome. Toxins (Basel) 2022;14:310. 
  24. Yi KH, Lee HJ, Choi YJ, Lee JH, Hu KS, Kim HJ. Intramuscular neural distribution of rhomboid muscles: evaluation for botulinum toxin injection using modified Sihler's method. Toxins (Basel) 2020;12:289. 
  25. Yi KH, Lee HJ, Hur HW, Seo KK, Kim HJ. Guidelines for botulinum neurotoxin injection for facial contouring. Plast Reconstr Surg 2022;150:562e-71e. 
  26. Yi KH, Lee JH, Kim GY, Yoon SW, Oh W, Kim HJ. Novel anatomical proposal for botulinum neurotoxin injection targeting lateral canthal rhytids. Toxins (Basel) 2022;14:462. 
  27. Yi KH, Lee JH, Kim HM, Kim HJ. The botulinum neurotoxin for pain control after breast reconstruction: neural distribution of the pectoralis major muscle. Reg Anesth Pain Med 2022;47:322-6. 
  28. Yi KH, Lee KL, Lee JH, Hu HW, Kim HJ. Guidance to trigger point injection for treating myofascial pain syndrome: intramuscular neural distribution of the quadratus lumborum. Clin Anat 2022;35:1100-6. 
  29. Yi KH, Lee JH, Lee K, Hu HW, Lee HJ, Kim HJ. Anatomical proposal for botulinum neurotoxin injection targeting the platysma muscle for treating platysmal band and jawline lifting: a review. Toxins (Basel) 2022;14:868. 
  30. Yi KH, Lee JH, Hur HW, Lee HJ, Choi YJ, Kim HJ. Distribution of the intramuscular innervation of the triceps brachii: clinical importance in the treatment of spasticity with botulinum neurotoxin. Clin Anat 2023 Jan 6 [Epub]. https://doi.org/10.1002/ca.24004 
  31. Zide BM, McCarthy J. The mentalis muscle: an essential component of chin and lower lip position. Plast Reconstr Surg 1989;83:413-20. 
  32. Hur MS, Kim HJ, Choi BY, Hu KS, Kim HJ, Lee KS. Morphology of the mentalis muscle and its relationship with the orbicularis oris and incisivus labii inferioris muscles. J Craniofac Surg 2013;24:602-4. 
  33. Garfein ES, Zide BM. Chin ptosis: classification, anatomy, and correction. Craniomaxillofac Trauma Reconstr 2008;1:1-14. 
  34. Seo KK. Botulinum toxin for Asians. Singapore: Springer; 2017. 
  35. Le Louarn C. Botulinum toxin A and facial lines: the variable concentration. Aesthetic Plast Surg 2001;25:73-84. 
  36. Klein AW. Contraindications and complications with the use of botulinum toxin. Clin Dermatol 2004;22:66-75. 
  37. Yu N, Liu Y, Chen C, Dong R, Yang E, Wang X. Paradoxical bulging of mentalis after botulinum toxin type A injection. J Cosmet Dermatol 2020;19:1290-3. 
  38. Carruthers J, Carruthers A. Aesthetic botulinum A toxin in the mid and lower face and neck. Dermatol Surg 2003;29:468-76.