title: The Anatomical Basis of Paradoxical Masseteric Bulging after Botulinum Neurotoxin Type A Injection.
abstract: The aim of this study was to determine the detailed anatomical structures of the superficial part of the masseter and to elucidate the boundaries and locations of the deep tendon structure within the superficial part of the masseter. Forty-four hemifaces from Korean and Thai embalmed cadavers were used in this study. The deep tendon structure was located deep in the lower third of the superficial part of the masseter. It was observed in all specimens and was designated as a deep inferior tendon (DIT). The relationship between the masseter and DIT could be classified into three types according to the coverage pattern: Type A, in which areas IV and V were covered by the DIT (27%, 12/44); Type B, in which areas V and VI were covered by the DIT (23%, 10/44); and Type C, in which areas IV, V, and VI were covered by the DIT (50%, 22/44). The superficial part of the masseter consists of not only the muscle belly but also the deep tendon structure. Based on the results obtained in this morphological study, we recommend performing layer-by-layer retrograde injections into the superficial and deep muscle bellies of the masseter.
authors.affiliation: Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul 03722, Korea. leehj221@yuhs.ac.
authors.forename: Hyung-Jin
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul 03722, Korea. inwon25@hotmail.com.
authors.forename: In-Won
authors.initials: IW
authors.lastname: Kang
authors.affiliation: Modelo Clinic, Seoul 06011, Korea. doctorseo@hotmail.com.
authors.forename: Kyle K
authors.initials: KK
authors.lastname: Seo
authors.affiliation: Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul 03722, Korea. cyj7797@yuhs.ac.
authors.forename: You-Jin
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: Department of Oral Medicine, TMJ and Orofacial Pain Clinic, Yonsei University College of Dentistry, Seoul 03722, Korea. k8756050@yuhs.ac.
authors.forename: Seong-Taek
authors.initials: ST
authors.lastname: Kim
authors.affiliation: Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul 03722, Korea. hks318@yuhs.ac.
authors.forename: Kyung-Seok
authors.initials: KS
authors.lastname: Hu
authors.affiliation: Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul 03722, Korea. hjk776@yuhs.ac.|Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonseiro, Seodaemun-gu, Seoul 03722, Korea. hjk776@yuhs.ac.
authors.forename: Hee-Jin
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D044466:Asian People; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005150:Facial Hemiatrophy / Q000188:drug therapy; D006801:Humans; D007267:Injections; D008406:Masseter Muscle / Q000033:anatomy & histology* / Q000187:drug effects*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D056910:Republic of Korea; D013710:Tendons / Q000033:anatomy & histology* / Q000187:drug effects*; D013785:Thailand
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: botulinum neurotoxin Type A injection; lower facial contour; paradoxical masseteric bulging; superficial part of masseter muscle