Anatomy and Cell Biology

Korean Association of Anatomists (대한해부학회)
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Sonographic observation of the paradoxical masseteric bulging and clinical implication of functional compartment

  • Kyu-Ho Yi (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry) ;
  • Hyungkyu Bae (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry) ;
  • Soo-Bin Kim (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry) ;
  • Woo-Ram Kim (Wyne Aesthetic Plastic Surgery Clinic) ;
  • Won Lee (Yonsei E1 Plastic Surgery Clinic) ;
  • Ji-Soo Kim (Dr Youth Clinic) ;
  • Hee-Jin Kim (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry)
  • Received : 2023.09.11
  • Accepted : 2023.12.28
  • Published : 2024.03.31
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Abstract

Masseter are commonly botulinum neurotoxin targeted muscle for facial contouring in aesthetic field. However, paradoxical masseteric bulging is common adverse effect that has not been discussed with ultrasonographic observations. Retrospective study has been conducted from October, 2021 to January, 2023, out of 324 patients have done blinded botulinum neurotoxin injection in the masseter at the middle and lower portion of the masseter with each side of 25 units (letibotulinum neurotoxin type A), 3 patients demonstrated paradoxical masseteric bulging has been reported and the image observed by ultrasonography by physician. Based on the observations made, we can infer that the function of the moving muscle involves twisting of the muscle fibers during contraction, along with the twisting of the deep inferior tendon, which causes the muscle to be divided into anterior and posterior compartments rather than into superficial and deep compartments of masseter. In ultrasonographic observe the skin surface of a patient with paradoxical masseteric bulging, it is observable that either the anterior or posterior part contracts significantly. The functional units of anterior and posterior compartment are observable as muscular contraction of inward movement of the muscle from either the anterior or posterior functional unit.

Keywords

Acknowledgement

This study was conducted in compliance with the principles set forth in the Declaration of Helsinki.

References

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