Anatomy and Cell Biology

Korean Association of Anatomists (대한해부학회)
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Novel anatomical proposal for botulinum neurotoxin injection targeting depressor anguli oris for treating drooping mouth corner

  • Kyu-Ho Yi (Wonju Public Health Center) ;
  • Ji-Hyun Lee (Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University) ;
  • Hye-Won Hu (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry) ;
  • You-Jin Choi (Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine) ;
  • Kangwoo Lee (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry) ;
  • Hyung-Jin Lee (Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea) ;
  • Hee-Jin Kim (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry)
  • Received : 2022.12.14
  • Accepted : 2023.01.25
  • Published : 2023.06.30
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Abstract

The depressor anguli oris (DAO) muscle is a thin, superficial muscle located below the corner of the mouth. It is the target for botulinum neurotoxin (BoNT) injection therapy, aimed at treating drooping mouth corners. Hyperactivity of the DAO muscle can lead to a sad, tired, or angry appearance in some patients. However, it is difficult to inject BoNT into the DAO muscle because its medial border overlaps with the depressor labii inferioris and its lateral border is adjacent to the risorius, zygomaticus major, and platysma muscles. Moreover, a lack of knowledge of the anatomy of the DAO muscle and the properties of BoNT can lead to side effects, such as asymmetrical smiles. Anatomical-based injection sites were provided for the DAO muscle, and the proper injection technique was reviewed. We proposed optimal injection sites based on the external anatomical landmarks of the face. The aim of these guidelines is to standardize the procedure and maximize the effects of BoNT injections while minimizing adverse events, all by reducing the dose unit and injection points.

Keywords

Acknowledgement

This study was conducted in compliance with the principles of the Declaration of Helsinki. Consent was received from the families of the deceased patients before beginning the dissection. The authors sincerely thank those who donated their bodies to science to enable anatomical research. The results of such research can potentially increase mankind's overall knowledge, and consequently, improve patient care. Therefore, these donors and their families deserve the greatest gratitude. The authors thank Eun-Byul Yi from the Eonbuk Elementary School for the illustrations.

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