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Accessory nerve distribution for aesthetic botulinum toxin injections into the upper trapezius muscle: anatomical study and clinical trial

Reproducible BoNT injection sites for upper trapezius

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Abstract

Purpose

The descending part of the trapezius muscle is clinically associated with neck pain and aesthetic applications. The innervation of the trapezius muscle is not well described in the medical literature for clinicians. The aim of study was to analyze the perforating branch pattern of the accessory nerve in the descending part of the trapezius muscle with the aim of describing the most efficient and reproducible BoNT injection sites for aesthetic treatment of shoulder contouring.

Methods

Twenty-six specimens (five male and eight female) from embalmed Korean cadavers were used in this study. The trapezius muscle was dissected scrupulously and then reflected to enable examination of the locations of the perforating points. The thickness of trapezius muscle was measured in 13 volunteers using a diagnostic ultrasonography system. BoNT was injected into the trapezius muscle bilaterally. Injections were performed at 6 points separated by 2 cm. The muscle thicknesses were measured three times using ultrasonography: before the injection and at 4 and 12 weeks after the injection.

Results

The dense arborization of the perforating accessory nerve branches was confined mostly to section b (66.7%, 54/81) and section c (33.3%, 27/81). The mean muscle thickness at 4 and 12 weeks consistently decreased 0.68–0.63 cm  in conventional method and 0.65–0.61 cm in new method (NDM) respectively (right and left).

Conclusion

To optimize the outcome of BoNT injection, we recommended injecting into six points separated by 2 cm in sections b and c of the upper trapezius muscle. It is significant that it is easier to apply to anyone than to apply unstructured techniques.

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Funding

This study was supported by Dae-Woong Pharmacetical Co., Ltd.

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Authors and Affiliations

  1. Division of Health Science, Department of Dental Hygiene, Dongseo University, Busan, South Korea

    Jung-Hee Bae

  2. Department of Orofacial Pain and Oral Medicine, Yonsei University College of Dentistry, Seoul, South Korea

    Ji-Soo Lee & Seong Taek Kim

  3. Department of Dental Hygiene, Baekseok University, Cheonan, South Korea

    Da-Yae Choi

  4. Chungdam i Plastic Surgery Clinic, Uijeongbu, South Korea

    JeongHoon Suhk

Authors
  1. Jung-Hee Bae
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  2. Ji-Soo Lee
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  3. Da-Yae Choi
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  4. JeongHoon Suhk
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  5. Seong Taek Kim
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Contributions

J-H Bae contributed to protocol, project development, data collection and analysis manuscript writing and editing. J-S Lee contributed to data collection and manuscript writing. D-Y Choi contributed to data collection and analysis. JH Suhk contributed to data collection. ST Kim contributed to protocol, project development, data management and manuscript editing. Jung-Hee Bae and Ji-Soo Lee contributed equally to this study.

Corresponding author

Correspondence to Seong Taek Kim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

All cadavers were donated legally to Dankook University and Yonsei University of Dentistry, Seoul, South Korea.

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Bae, JH., Lee, JS., Choi, DY. et al. Accessory nerve distribution for aesthetic botulinum toxin injections into the upper trapezius muscle: anatomical study and clinical trial. Surg Radiol Anat 40, 1253–1259 (2018). https://doi.org/10.1007/s00276-018-2059-4

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  • DOI: https://doi.org/10.1007/s00276-018-2059-4

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