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Diagnosis of zygomaticus muscle paralysis using needle electromyography with ultrasonography.

Yoo SH, Kwon HK, Lee SH, Lee SJ, Ha KW, Yun HS - Ann Rehabil Med (2013)

Bottom Line: A 22-year-old woman visited our clinic with a history of radiofrequency volumetric reduction for bilateral masseter muscles at a local medical clinic.Sono-guided needle EMG for zygomaticus muscle revealed spontaneous activities at rest and small amplitude motor unit potentials with reduced recruitment patterns on volition.Sono-guided needle EMG may be an optimal approach in focal facial nerve branch injury for the specific localization of the injury lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
A 22-year-old woman visited our clinic with a history of radiofrequency volumetric reduction for bilateral masseter muscles at a local medical clinic. Six days after the radiofrequency procedure, she noticed a facial asymmetry during smiling. Physical examination revealed immobility of the mouth drawing upward and laterally on the left. Routine nerve conduction studies and needle electromyography (EMG) in facial muscles did not suggest electrodiagnostic abnormalities. We assumed that the cause of facial asymmetry could be due to an injury of zygomaticus muscles, however, since defining the muscles through surface anatomy was difficult and it was not possible to identify the muscles with conventional electromyographic methods. Sono-guided needle EMG for zygomaticus muscle revealed spontaneous activities at rest and small amplitude motor unit potentials with reduced recruitment patterns on volition. Sono-guided needle EMG may be an optimal approach in focal facial nerve branch injury for the specific localization of the injury lesion.

No MeSH data available.


Related in: MedlinePlus

Clinical figures of face. (A) Resting state, (B) frontalis muscle activation, and (C) orbicularis oris muscle activation demonstrated symmetry on both sides. However, (D) zygomaticus muscle activation (on smiling) showed asymmetry.
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Figure 1: Clinical figures of face. (A) Resting state, (B) frontalis muscle activation, and (C) orbicularis oris muscle activation demonstrated symmetry on both sides. However, (D) zygomaticus muscle activation (on smiling) showed asymmetry.

Mentions: A 22-year-old woman visited our clinic complaining of left facial palsy that for four weeks. Five weeks earlier, the patient received radiofrequency volumetric reduction for masseter muscles in the bilateral buccal regions at a local medical clinic. Under local anesthesia, monopolar radiofrequency probes were inserted into the lower third of the masseter muscles through oral mucosa and coagulation was done at 20 to 30 spots in each masseter muscle. Her primary symptom was asymmetry of facial muscles. In physical examination, she was freely able to wrinkle the forehead, close the eyes completely, lift the nasal ala up and forward and contract the mouth. The only abnormal finding of the facial expression was an incomplete elevation of the left corner of the mouth when smiling (Fig. 1).


Diagnosis of zygomaticus muscle paralysis using needle electromyography with ultrasonography.

Yoo SH, Kwon HK, Lee SH, Lee SJ, Ha KW, Yun HS - Ann Rehabil Med (2013)

Clinical figures of face. (A) Resting state, (B) frontalis muscle activation, and (C) orbicularis oris muscle activation demonstrated symmetry on both sides. However, (D) zygomaticus muscle activation (on smiling) showed asymmetry.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713303&req=5

Figure 1: Clinical figures of face. (A) Resting state, (B) frontalis muscle activation, and (C) orbicularis oris muscle activation demonstrated symmetry on both sides. However, (D) zygomaticus muscle activation (on smiling) showed asymmetry.
Mentions: A 22-year-old woman visited our clinic complaining of left facial palsy that for four weeks. Five weeks earlier, the patient received radiofrequency volumetric reduction for masseter muscles in the bilateral buccal regions at a local medical clinic. Under local anesthesia, monopolar radiofrequency probes were inserted into the lower third of the masseter muscles through oral mucosa and coagulation was done at 20 to 30 spots in each masseter muscle. Her primary symptom was asymmetry of facial muscles. In physical examination, she was freely able to wrinkle the forehead, close the eyes completely, lift the nasal ala up and forward and contract the mouth. The only abnormal finding of the facial expression was an incomplete elevation of the left corner of the mouth when smiling (Fig. 1).

Bottom Line: A 22-year-old woman visited our clinic with a history of radiofrequency volumetric reduction for bilateral masseter muscles at a local medical clinic.Sono-guided needle EMG for zygomaticus muscle revealed spontaneous activities at rest and small amplitude motor unit potentials with reduced recruitment patterns on volition.Sono-guided needle EMG may be an optimal approach in focal facial nerve branch injury for the specific localization of the injury lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
A 22-year-old woman visited our clinic with a history of radiofrequency volumetric reduction for bilateral masseter muscles at a local medical clinic. Six days after the radiofrequency procedure, she noticed a facial asymmetry during smiling. Physical examination revealed immobility of the mouth drawing upward and laterally on the left. Routine nerve conduction studies and needle electromyography (EMG) in facial muscles did not suggest electrodiagnostic abnormalities. We assumed that the cause of facial asymmetry could be due to an injury of zygomaticus muscles, however, since defining the muscles through surface anatomy was difficult and it was not possible to identify the muscles with conventional electromyographic methods. Sono-guided needle EMG for zygomaticus muscle revealed spontaneous activities at rest and small amplitude motor unit potentials with reduced recruitment patterns on volition. Sono-guided needle EMG may be an optimal approach in focal facial nerve branch injury for the specific localization of the injury lesion.

No MeSH data available.


Related in: MedlinePlus