Publications by authors named "Kyu-Ho Yi"

26 Publications

  • Page 1 of 1

Novel Anatomical Proposal for Botulinum Neurotoxin Injection Targeting Lateral Canthal Rhytids.

Toxins (Basel) 2022 Jul 6;14(7). Epub 2022 Jul 6.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Korea.

Botulinum neurotoxin injections near the lateral canthal rhytids are commonly used in cosmetic settings; however, there is a lack of thorough anatomical knowledge, and an effective way to treat them with accumulating knowledge is needed. The anatomical characteristics concerning the injection of botulinum neurotoxin into the orbicularis oculi muscle were evaluated in this review. Current knowledge on the identification of botulinum neurotoxin injection points from recent anatomical research was assessed. The lateral canthal lines are involved with the orbicularis oculi muscle and nearby anatomical structures, and the injection points can be more precisely defined. The best possible injection sites were provided, and the injection procedure was described. This review proposes evidence for injection sites associated with the surface anatomy of the orbicularis oculi muscles to enhance the effectiveness of easing lateral canthal rhytids.
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http://dx.doi.org/10.3390/toxins14070462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9316553PMC
July 2022

Guidelines for botulinum neurotoxin injection for facial contouring.

Plast Reconstr Surg 2022 Jun 28. Epub 2022 Jun 28.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul, 03722, Republic of Korea.

Summary: The hypertrophied temporalis and masseter muscles give a muscular shaped and bulky contour to the face. Botulinum neurotoxin injection methods are commonly used for facial contouring; however, adverse effects have been reported owing to a lack of delicate anatomical information. The anatomical considerations when injecting botulinum neurotoxin into the temporalis and masseter muscles have been reviewed in the present study. Current knowledge on the localization of the botulinum neurotoxin injection point with more recent anatomical dissection and modified Sihler's staining procedures was assessed. We found that for the muscles, the injection point can be more precisely demarcated. Optimal injection sites are presented for the temporalis and masseter muscles, and the injection technique has been suggested. We propose the optimal injection sites in relation to external anatomical landmarks for the frequently injected muscles of the face to facilitate the efficiency of botulinum neurotoxin injections. In addition, these guidelines would aid in more precise practice without the adverse effects of botulinum neurotoxin.
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http://dx.doi.org/10.1097/PRS.0000000000009444DOI Listing
June 2022

Hyaluronic acid filler injection for deep nasolabial folds: A novel intraoral approach.

Clin Anat 2022 Sep 14;35(6):820-823. Epub 2022 Jun 14.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea.

Hyaluronic acid filler injection is a minimally invasive procedure for facial rejuvenation that involves injecting filling materials to correct the volume or augment specific areas in the face. Deep nasolabial folds are a common concern in aging people. The simplest way to correct a deep nasolabial fold to rejuvenate the face is to inject Ristow's space with hyaluronic acid fillers. However, conventional injection methods, such as percutaneous injections using a needle, can cause severe complications, such as skin necrosis or blindness due to intravascular injections. Therefore, the aim of the present study was to introduce a safe technique for intraoral filler injections in deep nasolabial folds and review related anatomic features to evaluate the safety of this technique.
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http://dx.doi.org/10.1002/ca.23919DOI Listing
September 2022

Guidance to trigger point injection for treating myofascial pain syndrome: Intramuscular neural distribution of the quadratus lumborum.

Clin Anat 2022 Jun 2. Epub 2022 Jun 2.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea.

Postural habits and repetitive motion contribute toward the progress of myofascial pain by affecting overload on specific muscles, the quadratus lumborum (QL) muscle being the most frequently involved. The therapy of myofascial pain syndrome includes the release of myofascial pain syndrome using injective agents such as botulinum neurotoxin, lidocaine, steroids, and normal saline. However, an optimal injection point has not been established for the QL muscle. This study aimed to propose an optimal injection point for this muscle by studying its intramuscular neural distribution using the whole mount staining method. A modified Sihler's procedure was completed on 15 QL muscles to visualize the intramuscular arborization areas in terms of the inferior border of the 12th rib, the transverse processes of L1-L4, and the iliac crest. The intramuscular neural distribution of the QL had the densely arborized areas in the three lateral portions of L3-L4 and L4-L5 and the medial portion between L4 and L5.
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http://dx.doi.org/10.1002/ca.23918DOI Listing
June 2022

Novel Anatomical Guidelines on Botulinum Neurotoxin Injection for Wrinkles in the Nose Region.

Toxins (Basel) 2022 05 15;14(5). Epub 2022 May 15.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Korea.

Botulinum neurotoxin injection surrounding the nose area is frequently used in aesthetic settings. However, there is a shortage of thorough anatomical understanding that makes it difficult to treat wrinkles in the nose area. In this study, the anatomical aspects concerning the injection of botulinum neurotoxin into the nasalis, procerus, and levator labii superioris alaeque muscles are assessed. In addition, the present knowledge on localizing the botulinum neurotoxin injection point from a newer anatomy study is assessed. It was observed that, for the line-associated muscles in the nose region, the injection point may be more precisely defined. The optimal injection sites are the nasalis, procerus, and levator labii superioris alaeque muscles, and the injection technique is advised. We advise the best possible injection sites in association with anatomical standards for commonly injected muscles to increase efficiency in the nose region by removing the wrinkles. Similarly, these suggestions support a more precise procedure.
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http://dx.doi.org/10.3390/toxins14050342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144745PMC
May 2022

Intramuscular Innervation of the Supraspinatus Muscle Assessed Using Sihler's Staining: Potential Application in Myofascial Pain Syndrome.

Toxins (Basel) 2022 04 28;14(5). Epub 2022 Apr 28.

BK21 FOUR Project, Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul 03722, Korea.

Despite the positive effects of botulinum neurotoxin (BoNT) injection into the neural arborized area, there is no anatomical evidence in the literature regarding the neural arborization of the supraspinatus muscle. The present study aimed to define the intramuscular neural arborized pattern of the supraspinatus muscle using the modified Sihler's staining method to facilitate the establishment of safe and effective injection sites in patients with myofascial pain in the supraspinatus muscle. Seventeen supraspinatus muscles from 15 embalmed cadavers were dissected. Precise suprascapular nerve entry locations were also observed. Intramuscular neural arborization was visualized by Sihler's staining. The supraspinatus muscle was divided into four portions named A, B, C, and D. The nerve entry points were observed in 88.2% (15 of 17 cases) of section B and 76.5% (13 of 17 cases) of section C of the supraspinatus muscle, respectively. The concentration of intramuscular neural arborization was highest in section B of the supraspinatus muscle, which was the center of the supraspinatus muscle. When the clinician performs a trigger point and a BoNT injection into the supraspinatus muscle, injection within the medial 25-75% of the supraspinatus muscle will lead to optimal results when using small amounts of BoNT and prevent undesirable paralysis.
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http://dx.doi.org/10.3390/toxins14050310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9143847PMC
April 2022

Intramuscular Neural Distribution of the Serratus Anterior Muscle: Regarding Botulinum Neurotoxin Injection for Treating Myofascial Pain Syndrome.

Toxins (Basel) 2022 04 11;14(4). Epub 2022 Apr 11.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, College of Dentistry, Yonsei University, Seoul 03722, Korea.

The serratus anterior muscle is commonly involved in myofascial pain syndrome and is treated with many different injective methods. Currently, there is no definite injection point for the muscle. This study provides a suggestion for injection points for the serratus anterior muscle considering the intramuscular neural distribution using the whole-mount staining method. A modified Sihler method was applied to the serratus anterior muscles (15 specimens). The intramuscular arborization areas were identified in terms of the anterior (100%), middle (50%), and posterior axillary line (0%), and from the first to the ninth ribs. The intramuscular neural distribution for the serratus anterior muscle had the largest arborization patterns in the fifth to the ninth rib portion of between 50% and 70%, and the first to the fourth rib portion had between 20% and 40%. These intramuscular neural distribution-based injection sites are in relation to the external anatomical line for the frequently injected muscles to facilitate the efficiency of botulinum neurotoxin injections. Lastly, the intramuscular neural distribution of serratus anterior muscle should be considered in order to practice more accurately without the harmful side effects of trigger-point injections and botulinum neurotoxin injections.
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http://dx.doi.org/10.3390/toxins14040271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9033065PMC
April 2022

Anatomical Proposal for Botulinum Neurotoxin Injection for Glabellar Frown Lines.

Toxins (Basel) 2022 04 10;14(4). Epub 2022 Apr 10.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seoul 03722, Korea.

Botulinum neurotoxin injection for treating glabellar frown lines is a commonly used method; however, side effects, such as ptosis and samurai eyebrow, have been reported due to a lack of comprehensive anatomical knowledge. The anatomical factors important for the injection of the botulinum neurotoxin into the corrugator supercilii muscle has been reviewed in this study. Current understanding on the localization of the botulinum neurotoxin injection point from newer anatomy examination was evaluated. We observed that for the glabellar-frown-line-related muscles, the injection point could be more accurately demarcated. We propose the injection method and the best possible injection sites for the corrugator supercilii muscle. We propose the optimal injection sites using external anatomical landmarks for the frequently injected muscles of the face to accelerate effective glabellar frown line removal. Moreover, these instructions would support a more accurate procedure without adverse events.
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http://dx.doi.org/10.3390/toxins14040268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032255PMC
April 2022

A novel needle-free microjet drug injector using Er:YAG LASER: A completely new concept of transdermal drug delivery system.

Clin Anat 2022 Jul 27;35(5):682-685. Epub 2022 Apr 27.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea.

The skin barrier effectively inhibits the penetration of substances; therefore, drug delivery, especially the delivery of drugs that are hydrophilic, through the skin, is challenging. Objectives: Physicians in the esthetic field now use the transdermal drug delivery system to attempt to deliver esthetic materials, such as hyaluronic acid and poly-DL-lactic acid into the skin. Conventionally, esthetic physicians manually injected these materials using needle syringes into the dermis layer. However, the injection is often irregular, imprecise, slow, and painful. Injector devices have been developed to overcome these limitations. A total of five Korean cadavers (that of three men and two women with a mean age of 69.2 years; range, 60-73 years) underwent laser injection. We used a device called Er:YAG LASER to create the pressure needed for microjet delivery to the skin of the cadaver. Discussion: In this study, the first LASER pressure-based, needle-free microjet injector was used to deliver drugs effectively into the dermis of a cadaver. This study showed that a novel needle-free microjet injector using Er:YAG LASER can introduce beneficial, liquid, esthetic drugs into the papillary dermal layer (depth of 300um) with minimal epidermal damage.
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http://dx.doi.org/10.1002/ca.23892DOI Listing
July 2022

Intramuscular Neural Arborization of the Latissimus Dorsi Muscle: Application of Botulinum Neurotoxin Injection in Flap Reconstruction.

Toxins (Basel) 2022 01 30;14(2). Epub 2022 Jan 30.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.

Postoperative pain after breast reconstruction surgery with the latissimus dorsi flap is a common occurrence. Botulinum neurotoxin (BoNT) injection during surgery is effective in reducing postoperative pain. This study aimed to determine the most appropriate locations for BoNT injection. A modified Sihler's method was performed on the latissimus dorsi muscles in 16 specimens. Intramuscular nerve arborization was noted under the landmark of the medial side surgical neck of the humerus to the line crossing the spinous process of T5 and the middle of the iliac crest. The latissimus dorsi muscles were divided into medial, middle, and lateral segments with 10 transverse divisions to give 10 sections (each 10%). Intramuscular nerve arborization of the latissimus dorsi muscle was the largest from the medial and lateral part of the muscle ranging from 40 to 60%, middle part from 30 to 60% and medial, middle and lateral part from 70 to 90%. The nerve entry points were at the medial and lateral part with 20-40% regarding the medial side of surgical neck of the humerus to the line crossing spinous process of T5 to the middle of iliac crest. These outcomes propose that an injection of BoNT into the latissimus dorsi muscles should be administered into specific zones.
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http://dx.doi.org/10.3390/toxins14020107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8878018PMC
January 2022

The botulinum neurotoxin for pain control after breast reconstruction: neural distribution of the pectoralis major muscle.

Reg Anesth Pain Med 2022 05 17;47(5):322-326. Epub 2022 Jan 17.

Yonsei University Medical Center, Seodaemun-gu, Korea

Introduction: The use of the botulinum neurotoxin injection is a growing area of research and clinical activity, with a focus on its role in facilitating postoperative pain management after reconstructive breast surgery. The study aimed to find out the standard injection points for botulinum neurotoxin injection by revealing the intramuscular nerve arborization of the pectoralis major.

Methods: Sihler's technique was conducted on the pectoralis major muscles (16 cadaveric specimens). The intramuscular nerve arborization was documented relative to the inferior border of the clavicle bone and lateral border of the sternum.

Results: After the staining, the pectoralis major was divided into fifths transversely from the inferior border of the clavicle and vertically into fifths from the lateral border of the sternum. Intramuscular nerve arborization of the pectoralis major muscle was the largest in the middle sections of the muscle belly.

Discussion: The results indicate that botulinum neurotoxin should be applied to the pectoralis major in certain regions. The regions of major arborization are optimal as the most effective and most reliable points for injecting botulinum neurotoxin.
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http://dx.doi.org/10.1136/rapm-2021-102653DOI Listing
May 2022

Botulinum neurotoxin injection guidelines regarding flap surgeries in breast reconstruction.

J Plast Reconstr Aesthet Surg 2022 Jan 30;75(1):503-505. Epub 2021 Oct 30.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea; Modelo Clinic, Apgujeong-ro 60 Gil 21, Seoul 06011, South Korea; Department of Materials Science & Engineering, College of Engineering, Yonsei University, Seoul 03722, South Korea. Electronic address:

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http://dx.doi.org/10.1016/j.bjps.2021.09.081DOI Listing
January 2022

Anatomical consideration of deep calf veins: application to catheter-directed thrombolysis.

Surg Radiol Anat 2021 Dec 25;43(12):2071-2076. Epub 2021 Aug 25.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Room 6 01, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.

Purpose: An antegrade approach is frequently used in catheter-directed thrombolysis to remove deep-vein thrombosis. However, the antegrade approach is difficult when accessing veins with small diameters; therefore, understanding the variation of deep calf vein is important.

Methods: This study measured the diameters and surface areas of the proximal and distal posterior tibial vein, peroneal vein, and anterior tibial vein to determine which are preferable for venous access. This study dissected 132 legs from Korean and Thai cadavers. The proximal and distal posterior tibial vein, peroneal vein, and anterior tibial vein were scanned and measured.

Results: The mean diameter and surface area were largest for the proximal tibial vein, at 6.34 mm and 0.312 cm, respectively, followed by the anterior tibial vein (5.22 mm and 0.213 cm), distal posterior tibial vein (3.29 mm and 0.091 cm), and peroneal vein (3.43 mm and 0.081 cm). The proximal posterior tibial vein and anterior tibial vein have large diameters and surface areas, which make them ideal for applying an antegrade approach in catheter-directed thrombolysis.

Conclusions: The distal posterior tibial vein and peroneal vein are not recommended due to their smaller surface areas and also the anatomical variations therein.
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http://dx.doi.org/10.1007/s00276-021-02821-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8385696PMC
December 2021

Anatomical locations of the motor endplates of sartorius muscle for botulinum toxin injections in treatment of muscle spasticity.

Surg Radiol Anat 2021 Dec 11;43(12):2025-2030. Epub 2021 Aug 11.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

Purpose: This study aimed to detect the idyllic locations for botulinum neurotoxin injection by analyzing the intramuscular neural distributions of the sartorius muscles.

Methods: An altered Sihler's staining was conducted on sartorius muscles (15 specimens). The nerve entry points and intramuscular arborization areas were measured as a percentage of the total distance from the most prominent point of the anterior superior iliac spine (0%) to the medial femoral epicondyle (100%).

Results: Intramuscular neural distribution were densely detected at 20-40% and 60-80% for the sartorius muscles. The result suggests that the treatment of sartorius muscle spasticity requires botulinum neurotoxin injections in particular locations.

Conclusions: These locations, corresponding to the locations of maximum arborization, are suggested as the most suggestive points for botulinum neurotoxin injection.
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http://dx.doi.org/10.1007/s00276-021-02813-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354843PMC
December 2021

Application of Botulinum Neurotoxin Injections in TRAM Flap for Breast Reconstruction: Intramuscular Neural Arborization of the Rectus Abdominis Muscle.

Toxins (Basel) 2021 04 9;13(4). Epub 2021 Apr 9.

Department of Oral Biology, Division in Anatomy and Developmental Biology, Human Identification Research Institute, BK 21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.

Breast reconstruction after mastectomy is commonly performed using transverse rectus abdominis myocutaneous (TRAM) flap. Previous studies have demonstrated that botulinum neurotoxin injections in TRAM flap surgeries lower the risk of necrosis and allow further expansion of arterial cross-sectional diameters. The study was designed to determine the ideal injection points for botulinum neurotoxin injection by exploring the arborization patterns of the intramuscular nerves of the rectus abdominis muscle. A modified Sihler's method was performed on 16 rectus abdominis muscle specimens. Arborization of the intramuscular nerves was determined based on the most prominent point of the xyphoid process to the pubic crest. All 16 rectus abdominis muscle specimens were divided into four muscle bellies by the tendinous portion. The arborized portions of the muscles were located on the 5-15%, 25-35%, 45-55%, and 70-80% sections of the 1st, 2nd, 3rd, and 4th muscle bellies, respectively. The tendinous portion was located at the 15-20%, 35-40%, 55-60%, and 90-100% sections. These results suggest that botulinum neurotoxin injections into the rectus abdominis muscles should be performed in specific sections.
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http://dx.doi.org/10.3390/toxins13040269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070362PMC
April 2021

Guidelines for botulinum neurotoxin injections in piriformis syndrome.

Clin Anat 2021 Oct 31;34(7):1028-1034. Epub 2020 Dec 31.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea.

Background: The piriformis muscle is normally involved in piriformis syndrome and can be treated with botulinum neurotoxin using several different injection methods. However, definitive injection guidelines for the muscle have not been reported previously.

Aims: This study aimed to determine the ideal area for injections based on the intramuscular nerve distribution as obtained using a modified Sihler's staining technique.

Materials And Methods: A modified Sihler's method was applied to the piriformis muscle in 15 specimens. The intramuscular arborization areas were identified based on two anatomical landmarks: (a) the lateral border of the sacrum bone and (b) the greater trochanter.

Results: The nerve entry point for both piriformis muscles was found in the area between the lateral border of the sacrum and one-fifth of the distance toward the greater trochanter. The intramuscular nerve distribution for the piriformis muscle had the largest arborization patterns between one-fifth and two-fifths of the distance from the sacrum to the greater trochanter. The piriformis muscle was tendinous from two-fifths of the distance to the greater trochanter.

Discussion: This study has yielded suggested optimal injection locations for the piriformis muscle relative to external anatomical landmarks.

Conclusion: Clinicians can use these guidelines to ensure the effectiveness of not only botulinum neurotoxin injections but also other agents such as steroids, anesthetics, and normal saline. These guidelines will also help to avoid adverse outcomes of injection treatments.
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http://dx.doi.org/10.1002/ca.23711DOI Listing
October 2021

Anatomical guide for botulinum neurotoxin injection: Application to cosmetic shoulder contouring, pain syndromes, and cervical dystonia.

Clin Anat 2021 Sep 12;34(6):822-828. Epub 2020 Oct 12.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea.

Introduction: This study proposes an ideal botulinum toxin injection point of the trapezius muscle for shoulder line contouring, pain management, and functional impairment. This study describes the intramuscular nerve branching in the trapezius muscle, providing essential information for botulinum neurotoxin injection.

Method: A modified Sihler's method was performed on the trapezius muscles (16 specimens). The intramuscular arborization areas were elucidated regarding the external occipital protuberance superiorly, spinous process of the 12th thoracic vertebra inferiorly and acromion of the scapula.

Result: The intramuscular neural distribution for the superior, middle, and inferior regions of the trapezius muscle had the greatest arborized patterns in the horizontal 1/5-2/5 and vertical 2/10-4/10 sections, the horizontal 1/5-3/5 and vertical 4/10-5/10 sections, and the horizontal 1/5-2/5 and vertical 5/10-7/10 sections, respectively.

Discussion: We propose that BoNT treatments should be directed to the horizontal 1/5-2/5 and vertical 2/10-4/10 sections of the superior trapezius, the horizontal 1/5-3/5 and vertical 4/10-5/10 sections of the middle trapezius and the horizontal 1/5-2/5 and vertical 5/10-7/10 sections of the inferior trapezius. Additionally, injective treatment at the horizontal 2/5-3/5 and vertical 2/10-4/10 nerve entry points should be avoided to prevent nerve trunk damage causing paralysis. According to our guidelines, clinicians can ensure minimal dose injections and fewer adverse effects in botulinum neurotoxin injective treatment.
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http://dx.doi.org/10.1002/ca.23690DOI Listing
September 2021

Is variation in posterior tibial veins a risk factor for deep-vein thrombosis?

Clin Anat 2021 Sep 12;34(6):829-834. Epub 2020 Oct 12.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea.

Introduction: This study proposes variations in the posterior tibial vein as one of the risk factors for deep-vein thrombosis. Understanding the anatomical classification of the posterior tibial vein would guide the antegrade approach of catheter-directed thrombolysis.

Materials And Methods: One hundred thirty-four legs from Korean and Thai cadavers were dissected. The posterior tibial veins were classified into four types according to the number of proximal and distal veins.

Results: The most common type was type Ia (64/134), followed by type IIa (28/134), type Ib (24/134), and type IIb (16/134).

Conclusions: The anterior tibial and fibular veins had exactly two paired veins; however, the posterior tibial vein had many variations. We assume that patients with type IIb and IIa have a higher risk of thrombosis and hidden symptoms due to collateral formation. Additionally, the classification of the posterior tibial vein and dividing into proximal and distal posterior tibial vein would help practitioners predict the course and guide the application of catheter-directed thrombolysis.
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http://dx.doi.org/10.1002/ca.23691DOI Listing
September 2021

Effective botulinum neurotoxin injection in treating iliopsoas spasticity.

Clin Anat 2021 Apr 9;34(3):431-436. Epub 2020 Sep 9.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea.

Introduction: To detect ideal locations for botulinum toxin (BoNT) injection by exploring the intramuscular nerve arborization of the psoas major and iliacus muscles.

Method: A modified Sihler's method was performed on the psoas major and iliacus muscles (16 specimens each). Intramuscular nerve arborization was recorded according to the most prominent point of the anterior superior iliac spine (ASIS), the posterior superior iliac spine (PSIS), the lesser trochanter (LT), and the transverse process of the 12th thoracic vertebra.

Results: Intramuscular nerve arborization of the psoas major muscle was the largest from 1/5 to 3/5 the distance from the transverse process of the 12th thoracic vertebra to the PSIS, and the tendinous portion of the muscle occupied from 3/5 to 5/5 this distance. In terms of the plane of the ASIS, the PSIS, and the LT, the arborization of the iliacus muscle was the largest from 1/5 to 3/5 the horizontal distance and 0 to 1/3, the distance longitudinally, and from 1/5 to 2/5, the horizontal distance and 1/3 to 2/3, the longitudinal distance.

Discussion: These results suggest that an injection of BoNT to the psoas major and iliacus muscle should be applied in specific areas. Additionally, the posterior approach is an ideal method for targeting only the psoas major because the injection point is above the PSIS. However, when treating both the psoas major and iliacus muscles, the proximal anterior approach is an ideal method according to the arborization patterns.
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http://dx.doi.org/10.1002/ca.23670DOI Listing
April 2021

Intramuscular Neural Distribution of Rhomboid Muscles: Evaluation for Botulinum Toxin Injection Using Modified Sihler's Method.

Toxins (Basel) 2020 05 3;12(5). Epub 2020 May 3.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.

This study describes the nerve entry point and intramuscular nerve branching of the rhomboid major and minor, providing essential information for improved performance of botulinum toxin injections and electromyography. A modified Sihler method was performed on the rhomboid major and minor muscles (10 specimens each). The nerve entry point and intramuscular arborization areas were identified in terms of the spinous processes and medial and lateral angles of the scapula. The nerve entry point for both the rhomboid major and minor was found in the middle muscular area between levels C7 and T1. The intramuscular neural distribution for the rhomboid minor had the largest arborization patterns in the medial and lateral sections between levels C7 and T1. The rhomboid major muscle had the largest arborization area in the middle section between levels T1 and T5. In conclusion, botulinum neurotoxin injection and electromyography should be administered in the medial and lateral sections of C7-T1 for the rhomboid minor and the middle section of T1-T7 for the rhomboid major. Injections in the middle section of C7-T1 should also be avoided to prevent mechanical injury to the nerve trunk. Clinicians can administer safe and effective treatments with botulinum toxin injections and other types of injections by following the methods in our study.
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http://dx.doi.org/10.3390/toxins12050289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291336PMC
May 2020

Effective botulinum toxin injection guide for treatment of cervical dystonia.

Clin Anat 2020 Mar 25;33(2):192-198. Epub 2019 Jul 25.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea.

The aim of this study was to elucidate the distribution of the accessory nerve within the sternocleidomastoid muscle (SCM) to aid identifying the optimum sites for botulinum neurotoxin (BoNT) injections and applying chemical neurolysis. Thirty SCM specimens from 15 Korean cadavers were used in this study. Sihler's staining was applied to 10 of the SCM specimens. Transverse lines were drawn in 20 sections to divide the SCM into 10 divisions vertically, and a vertical line was drawn into the medial and lateral halves from the mastoid process to the sternoclavicular joint. The most densely innervated areas were 5/10-6/10 and 6/10-7/10 along the lateral and medial parts of the muscle, respectively. We suggest injecting BoNT in the medial region 6/10-7/10 along the SCM prior to injecting in the lateral region 5/10-6/10 along the muscle to ensure safe and effective treatment. Clin. Anat. 33:192-198, 2020. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23430DOI Listing
March 2020

Reply.

Muscle Nerve 2016 09 7;54(3):513-4. Epub 2016 Jul 7.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea.

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http://dx.doi.org/10.1002/mus.25215DOI Listing
September 2016

Intramuscular nerve distribution of the hamstring muscles: Application to treating spasticity.

Clin Anat 2016 Sep 13;29(6):746-51. Epub 2016 Jun 13.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea.

The aim of this article is to elucidate the ideal sites for botulinum toxin injection by examining the intramuscular nerve distributions in the hamstring muscles. The hamstring muscles, biceps femoris, semitendinosus, and semimembranosus (10 specimens each) were stained by the modified Sihler method. The locations of the muscle origins, nerve entry points, and intramuscular arborized areas were recorded as percentages of the total distance from the line crossing the medial and lateral tibial condyles (0%) to the ischial tuberosity (100%). Intramuscular arborization patterns were observed at 15-30% and 50-60% for the biceps femoris, 25-40% and 60-80% for the semitendinosus, and 20-40% for the semimembranosus. This study suggests that botulinum toxin injection for spasticity of the hamstring muscles should be targeted to specific areas. These areas, where the arborization of intramuscular nerve branches is maximal, are recommended as the most effective and safest points for injection. Clin. Anat. 29:746-751, 2016. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.22735DOI Listing
September 2016

Neuromuscular structure of the tibialis anterior muscle for functional electrical stimulation.

Surg Radiol Anat 2017 Jan 20;39(1):77-83. Epub 2016 May 20.

Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.

Purpose: This study describes the nerve entry points and intramuscular nerve branching of the tibialis anterior, providing essential information for therapeutic functional electrical stimulation and botulinum toxin injection.

Methods: One hundred and ten legs from Korean and Thai cadavers were dissected. Ten specimens were harvested and subjected to modified Sihler's staining.

Results: The average total length from the lateral malleolus to the fibular head was 32.0 cm (SD 1.9). The nerve entry points were densely distributed between 86.5 and 90.6 % of the reference length, where the first and second nerve entry points were observable. A densely arborizing area of the intramuscular nerve branches was observed at 70-80 % of the reference length.

Conclusions: Based on the results of this study, clinicians can increase the effectiveness of therapeutic functional electrical stimulation and identify the ideal sites for botulinum toxin injection to the tibialis anterior muscle.
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http://dx.doi.org/10.1007/s00276-016-1698-6DOI Listing
January 2017

Intramuscular nerve distribution pattern of ankle invertor muscles in human cadaver using sihler stain.

Muscle Nerve 2016 May 4;53(5):742-7. Epub 2016 Feb 4.

Division in Anatomy and Developmental Biology, Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.

Introduction: We sought to the ideal sites for botulinum toxin injection by examining the intramuscular nerve patterns of the ankle invertors.

Methods: A modified Sihler method was performed on the flexor hallucis longus, tibialis posterior, and flexor digitorum longus muscles (10 specimens each). The muscle origins, nerve entry points, and intramuscular arborization areas were measured as a percentage of the total distance from the most prominent point of the lateral malleolus (0%) to the fibular head (100%).

Results: Intramuscular arborization patterns were observed at 20-50% for the flexor hallucis longus, 70-80% for the tibialis posterior, and 30-40% for the flexor digitorum longus.

Conclusions: These findings suggest that treatment of muscle spasticity of the ankle invertors involves botulinum toxin injections in specific areas. These areas, corresponding to the areas of maximum arborization, are recommended as the most effective and safest points for injection.
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http://dx.doi.org/10.1002/mus.24939DOI Listing
May 2016

Anatomic Study of the Dorsalis Pedis Artery, First Metatarsal Artery, and Second Metatarsal Bone for Mandibular Reconstruction.

J Oral Maxillofac Surg 2015 Aug 17;73(8):1627-36. Epub 2015 Feb 17.

Associate Professor, Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institution, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea. Electronic address:

Purpose: The purpose of this study was to clarify the anatomic variation of the dorsalis pedis and first metatarsal arteries and to define the trabecular-to-cortical bone ratio (TBR) of the second metatarsal bone to ascertain their suitability as implants.

Materials And Methods: Fifty-two specimens were prepared for this study. Each specimen was dissected on the dorsal side of the foot to search for the dorsalis pedis artery.

Results: Three types of dorsalis pedis artery were found: in type A, which was the most common, the artery continuously formed the first metatarsal artery; in type C, which was the second most common, the artery coursed below the first dorsal interosseous muscle; and in type B, the artery coursed from the lateral side. Five variations of the first metatarsal artery were identified: the most common was type IIb, in which the artery coursed below the first dorsal interosseous muscle; followed by type Ib, in which the artery coursed obliquely through the muscle; type Ic, in which the artery coursed parallel to the muscle; type IIa, in which the artery coursed above and below the muscle; and type Ia, in which the artery coursed only above the muscle. The second metatarsal bone was divided into 5 regions. There was no trabecular bone in regions 1 and 5. The TBR appeared to be lower in region 3 than in regions 2 and 4 and highest in region 2.

Conclusion: All regions of the second metatarsal bone appear to be suitable as implants, but when placing the implant in the proximal end, care should be taken not to overheat the bone and to be wary of perforation when placing it on the middle side.
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http://dx.doi.org/10.1016/j.joms.2015.02.007DOI Listing
August 2015
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