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Effective Botulinum Toxin Injection Guide for Treatment of Temporal Headache

View Article: PubMed Central - PubMed

ABSTRACT

This study involved an extensive analysis of published research on the morphology of the temporalis muscle in order to provide an anatomical guideline on how to distinguish the temporalis muscle and temporalis tendon by observing the surface of the patient’s face. Twenty-one hemifaces of cadavers were used in this study. The temporalis muscles were dissected clearly for morphological analysis between the temporalis muscle and tendon. The posterior border of the temporalis tendon was classified into three types: in Type I the posterior border of the temporalis tendon is located in front of reference line L2 (4.8%, 1/21), in Type II it is located between reference lines L2 and L3 (85.7%, 18/21), and in Type III it is located between reference lines L3 and L4 (9.5%, 2/21). The vertical distances between the horizontal line passing through the jugale (LH) and the temporalis tendon along each of reference lines L0, L1, L2, L3, and L4 were 29.7 ± 6.8 mm, 45.0 ± 8.8 mm, 37.7 ± 11.1 mm, 42.5 ± 7.5 mm, and 32.1 ± 0.4 mm, respectively. BoNT-A should be injected into the temporalis muscle at least 45 mm vertically above the zygomatic arch. This will ensure that the muscle region is targeted and so produce the greatest clinical effect with the minimum concentration of BoNT-A.

No MeSH data available.


The temporalis muscle and tendon could be clearly distinguished after Sihler’s staining (white dotted line). The temporalis tendon appeared as a fan beginning at the point where it is inserted into the temporalis muscle. The temporalis muscle occupied the remaining area. The nerve trunk of the deep temporal nerve traversed the temporalis tendon (white arrows). The nerve endings of the deep temporal nerve mainly dispersed in the temporalis muscle (black arrows).
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toxins-08-00265-f005: The temporalis muscle and tendon could be clearly distinguished after Sihler’s staining (white dotted line). The temporalis tendon appeared as a fan beginning at the point where it is inserted into the temporalis muscle. The temporalis muscle occupied the remaining area. The nerve trunk of the deep temporal nerve traversed the temporalis tendon (white arrows). The nerve endings of the deep temporal nerve mainly dispersed in the temporalis muscle (black arrows).

Mentions: The temporalis is a masticatory muscle that can be divided into anterior, middle, and posterior regions. Sihler’s staining showed that the anterior branch of the deep temporal nerve runs through the anterior fibers of the temporalis muscle, which provides upward elevation of the mandible. The posterior branch of the deep temporal nerve runs through the posterior fibers of the temporalis muscle, which provides backward elevation of the mandible. The middle branch of the deep temporal nerve runs through the middle fibers of the temporalis muscle (Figure 5).


Effective Botulinum Toxin Injection Guide for Treatment of Temporal Headache
The temporalis muscle and tendon could be clearly distinguished after Sihler’s staining (white dotted line). The temporalis tendon appeared as a fan beginning at the point where it is inserted into the temporalis muscle. The temporalis muscle occupied the remaining area. The nerve trunk of the deep temporal nerve traversed the temporalis tendon (white arrows). The nerve endings of the deep temporal nerve mainly dispersed in the temporalis muscle (black arrows).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037491&req=5

toxins-08-00265-f005: The temporalis muscle and tendon could be clearly distinguished after Sihler’s staining (white dotted line). The temporalis tendon appeared as a fan beginning at the point where it is inserted into the temporalis muscle. The temporalis muscle occupied the remaining area. The nerve trunk of the deep temporal nerve traversed the temporalis tendon (white arrows). The nerve endings of the deep temporal nerve mainly dispersed in the temporalis muscle (black arrows).
Mentions: The temporalis is a masticatory muscle that can be divided into anterior, middle, and posterior regions. Sihler’s staining showed that the anterior branch of the deep temporal nerve runs through the anterior fibers of the temporalis muscle, which provides upward elevation of the mandible. The posterior branch of the deep temporal nerve runs through the posterior fibers of the temporalis muscle, which provides backward elevation of the mandible. The middle branch of the deep temporal nerve runs through the middle fibers of the temporalis muscle (Figure 5).

View Article: PubMed Central - PubMed

ABSTRACT

This study involved an extensive analysis of published research on the morphology of the temporalis muscle in order to provide an anatomical guideline on how to distinguish the temporalis muscle and temporalis tendon by observing the surface of the patient’s face. Twenty-one hemifaces of cadavers were used in this study. The temporalis muscles were dissected clearly for morphological analysis between the temporalis muscle and tendon. The posterior border of the temporalis tendon was classified into three types: in Type I the posterior border of the temporalis tendon is located in front of reference line L2 (4.8%, 1/21), in Type II it is located between reference lines L2 and L3 (85.7%, 18/21), and in Type III it is located between reference lines L3 and L4 (9.5%, 2/21). The vertical distances between the horizontal line passing through the jugale (LH) and the temporalis tendon along each of reference lines L0, L1, L2, L3, and L4 were 29.7 ± 6.8 mm, 45.0 ± 8.8 mm, 37.7 ± 11.1 mm, 42.5 ± 7.5 mm, and 32.1 ± 0.4 mm, respectively. BoNT-A should be injected into the temporalis muscle at least 45 mm vertically above the zygomatic arch. This will ensure that the muscle region is targeted and so produce the greatest clinical effect with the minimum concentration of BoNT-A.

No MeSH data available.