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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 position of the temporalis tendon can be easily determined first aligning the thumb and first finger in a flat stretched-out state and then placing the second finger on the inferior margin of the zygomatic arch. The tip of the thumb is then located approximately 45 mm from the superior margin of the zygomatic arch. However, since every clinician varies in thumb length, we recommend that a clinician use the above-mentioned method after taking into consideration the difference when comparing the point 45 mm from the patient’s zygomatic arch with that of the location of his/her own thumb.
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toxins-08-00265-f006: The position of the temporalis tendon can be easily determined first aligning the thumb and first finger in a flat stretched-out state and then placing the second finger on the inferior margin of the zygomatic arch. The tip of the thumb is then located approximately 45 mm from the superior margin of the zygomatic arch. However, since every clinician varies in thumb length, we recommend that a clinician use the above-mentioned method after taking into consideration the difference when comparing the point 45 mm from the patient’s zygomatic arch with that of the location of his/her own thumb.

Mentions: The temporalis tendon can be easily found by first aligning the thumb and the first finger in a flat stretched-out state and then placing the second finger on the inferior margin of the zygomatic arch. This will result in the tip of the thumb being located approximately 45 mm from the superior margin of the zygomatic arch (Figure 6). This method makes it easy to identify the temporalis muscle and therefore also the effective injection site for BoNT-A.


Effective Botulinum Toxin Injection Guide for Treatment of Temporal Headache
The position of the temporalis tendon can be easily determined first aligning the thumb and first finger in a flat stretched-out state and then placing the second finger on the inferior margin of the zygomatic arch. The tip of the thumb is then located approximately 45 mm from the superior margin of the zygomatic arch. However, since every clinician varies in thumb length, we recommend that a clinician use the above-mentioned method after taking into consideration the difference when comparing the point 45 mm from the patient’s zygomatic arch with that of the location of his/her own thumb.
© Copyright Policy
Related In: Results  -  Collection

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

toxins-08-00265-f006: The position of the temporalis tendon can be easily determined first aligning the thumb and first finger in a flat stretched-out state and then placing the second finger on the inferior margin of the zygomatic arch. The tip of the thumb is then located approximately 45 mm from the superior margin of the zygomatic arch. However, since every clinician varies in thumb length, we recommend that a clinician use the above-mentioned method after taking into consideration the difference when comparing the point 45 mm from the patient’s zygomatic arch with that of the location of his/her own thumb.
Mentions: The temporalis tendon can be easily found by first aligning the thumb and the first finger in a flat stretched-out state and then placing the second finger on the inferior margin of the zygomatic arch. This will result in the tip of the thumb being located approximately 45 mm from the superior margin of the zygomatic arch (Figure 6). This method makes it easy to identify the temporalis muscle and therefore also the effective injection site for BoNT-A.

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.