Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin

Woo Sang Hwang, Mi Sun Hur, Kyung Seok Hu, Wu Chul Song, Ki Seok Koh, Hyoung Seon Baik, Seong Taek Kimo, Hee Jin Kim, Kee Joon Lee

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Objective: To propose a safe and reproducible injection point for botulinum toxin-A (BTX-A) as a supplementary method for the treatment of gummy smile, as determined by assessment of the morphologic characteristics of three lip elevator muscles. Materials and Methods: A total of 50 hemi-faces from 25 adult cadavers (male 13, female 12; ages, 47 to 88 years) were used in this study. Topographic relations and the directions of the lip elevator muscles (ie, levator labii superioris [LLS], levator labii superioris alaeque nasi [LLSAN], and zygomaticus minor [ZMi]), were investigated. Possible injection points were examined through the study of predetermined surface landmarks. Results: The insertion of the LLS was covered partially or entirely by the LLSAN and the ZMi, and the three muscles converged on the area lateral to the ala. The mean angle between the facial midline and each muscle vector was 25.8 ± 4.8 degrees for the LLS, 55.7 ± 6.4 degrees for the ZMi, and -20.2 ± 3.2 degrees for the LLSAN; no significant differences were noted between male and female subjects or between left and right sides. The three vectors passed near a triangular region formed by three surface landmarks. The center of this triangle, named the "Yonsei point", was suggested as an appropriate injection point for BTX-A. The clinical effectiveness of the injection point was demonstrated in selected cases with or without orthodontic treatment. Conclusions: Under careful case selection, BTX-A may be an effective treatment alternative for patients with excessive gingival display caused by hyperactive lip elevator muscles.

Original languageEnglish
Pages (from-to)70-77
Number of pages8
JournalAngle Orthodontist
Volume79
Issue number1
DOIs
Publication statusPublished - 2009 Jan 1

Fingerprint

Elevators and Escalators
Botulinum Toxins
Lip
Anatomy
Muscles
Type A Botulinum Toxins
Injections
Therapeutics
Orthodontics
Cadaver

All Science Journal Classification (ASJC) codes

  • Orthodontics

Cite this

Hwang, Woo Sang ; Hur, Mi Sun ; Hu, Kyung Seok ; Song, Wu Chul ; Koh, Ki Seok ; Baik, Hyoung Seon ; Kimo, Seong Taek ; Kim, Hee Jin ; Lee, Kee Joon. / Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. In: Angle Orthodontist. 2009 ; Vol. 79, No. 1. pp. 70-77.
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abstract = "Objective: To propose a safe and reproducible injection point for botulinum toxin-A (BTX-A) as a supplementary method for the treatment of gummy smile, as determined by assessment of the morphologic characteristics of three lip elevator muscles. Materials and Methods: A total of 50 hemi-faces from 25 adult cadavers (male 13, female 12; ages, 47 to 88 years) were used in this study. Topographic relations and the directions of the lip elevator muscles (ie, levator labii superioris [LLS], levator labii superioris alaeque nasi [LLSAN], and zygomaticus minor [ZMi]), were investigated. Possible injection points were examined through the study of predetermined surface landmarks. Results: The insertion of the LLS was covered partially or entirely by the LLSAN and the ZMi, and the three muscles converged on the area lateral to the ala. The mean angle between the facial midline and each muscle vector was 25.8 ± 4.8 degrees for the LLS, 55.7 ± 6.4 degrees for the ZMi, and -20.2 ± 3.2 degrees for the LLSAN; no significant differences were noted between male and female subjects or between left and right sides. The three vectors passed near a triangular region formed by three surface landmarks. The center of this triangle, named the {"}Yonsei point{"}, was suggested as an appropriate injection point for BTX-A. The clinical effectiveness of the injection point was demonstrated in selected cases with or without orthodontic treatment. Conclusions: Under careful case selection, BTX-A may be an effective treatment alternative for patients with excessive gingival display caused by hyperactive lip elevator muscles.",
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Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. / Hwang, Woo Sang; Hur, Mi Sun; Hu, Kyung Seok; Song, Wu Chul; Koh, Ki Seok; Baik, Hyoung Seon; Kimo, Seong Taek; Kim, Hee Jin; Lee, Kee Joon.

In: Angle Orthodontist, Vol. 79, No. 1, 01.01.2009, p. 70-77.

Research output: Contribution to journalArticle

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N2 - Objective: To propose a safe and reproducible injection point for botulinum toxin-A (BTX-A) as a supplementary method for the treatment of gummy smile, as determined by assessment of the morphologic characteristics of three lip elevator muscles. Materials and Methods: A total of 50 hemi-faces from 25 adult cadavers (male 13, female 12; ages, 47 to 88 years) were used in this study. Topographic relations and the directions of the lip elevator muscles (ie, levator labii superioris [LLS], levator labii superioris alaeque nasi [LLSAN], and zygomaticus minor [ZMi]), were investigated. Possible injection points were examined through the study of predetermined surface landmarks. Results: The insertion of the LLS was covered partially or entirely by the LLSAN and the ZMi, and the three muscles converged on the area lateral to the ala. The mean angle between the facial midline and each muscle vector was 25.8 ± 4.8 degrees for the LLS, 55.7 ± 6.4 degrees for the ZMi, and -20.2 ± 3.2 degrees for the LLSAN; no significant differences were noted between male and female subjects or between left and right sides. The three vectors passed near a triangular region formed by three surface landmarks. The center of this triangle, named the "Yonsei point", was suggested as an appropriate injection point for BTX-A. The clinical effectiveness of the injection point was demonstrated in selected cases with or without orthodontic treatment. Conclusions: Under careful case selection, BTX-A may be an effective treatment alternative for patients with excessive gingival display caused by hyperactive lip elevator muscles.

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