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Çiçek F, Çınaroğlu S, Ceranoğlu FG, Küçük E, Zor KR. Evaluation of nerve innervation distribution of orbicularis oculi muscle for botulinum neurotoxin application using Sihler's method. Ann Anat 2024; 251:152165. [PMID: 37804929 DOI: 10.1016/j.aanat.2023.152165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Blepharospasm is the involuntary and forced closure of the eyelids due to spasm-like contraction of the orbicularis oculi muscle around the eye. The study aimed to reveal the nerve innervation of the orbicularis oculi muscle for Botulinum neurotoxin (BoNT) treatment of blepharospasm by Sihler's staining technique. METHODS This study used six cephalus (12 orbicularis oculi muscles) with an average age of 69,6 (62-88) years. Then, the orbicularis oculi muscles were removed by dissection, and Sihler's staining technique was applied to the muscles. The limit for dissection of the muscle is the orbital opening level, where the nerves enter the muscle, and the muscle attaches to the bone. RESULTS In the region above the palpebral fissure, the nerves entering the muscle were densely located in the superolateral quadrant between 9 and 12 o'clock in the right eye and between 12 and 3 o'clock in the left eye. In the region under the palpebral fissure, the nerves' density in the orbicularis oculi muscle was higher between 4 and 7 o'clock in the right eye and between 5 and 8 o'clock in the left eye. CONCLUSION This study unveiled the nerve branches associated with the orbicularis oculi muscle. It pinpointed precise crossing points of these nerve branches, which can be targeted for applying BoNT in treating blepharospasm. Consequently, by utilizing minimal BoNT, it is anticipated that the quantity of toxin administered will decrease, leading to more efficient outcomes and reduced expenses. Furthermore, this approach can aid in averting potential undesired complications during BoNT administration.
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Affiliation(s)
- Fatih Çiçek
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240 Niğde, Turkiye.
| | - Selim Çınaroğlu
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240 Niğde, Turkiye
| | - Faruk Gazi Ceranoğlu
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240 Niğde, Turkiye
| | - Erkut Küçük
- Department of Ophthalmology, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240 Niğde, Turkiye
| | - Kürşad Ramazan Zor
- Department of Ophthalmology, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240 Niğde, Turkiye
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Lee HJ, Lee JH, Yi KH, Kim HJ. Intramuscular Innervation of the Supraspinatus Muscle Assessed Using Sihler’s Staining: Potential Application in Myofascial Pain Syndrome. Toxins (Basel) 2022; 14:toxins14050310. [PMID: 35622557 PMCID: PMC9143847 DOI: 10.3390/toxins14050310] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
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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Affiliation(s)
- Hyung-Jin Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Ji-Hyun Lee
- 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; (J.-H.L.); (K.-H.Y.)
| | - Kyu-Ho Yi
- 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; (J.-H.L.); (K.-H.Y.)
- COVID-19 Division, Wonju City Public Health Center, Wonju-Si 26417, Korea
| | - Hee-Jin Kim
- 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; (J.-H.L.); (K.-H.Y.)
- Department of Materials Science & Engineering, College of Engineering, Yonsei University, Seoul 03722, Korea
- Correspondence:
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Wysiadecki G, Radek M, Tubbs RS, Iwanaga J, Walocha J, Brzeziński P, Polguj M. Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery. Brain Sci 2021; 11:brainsci11050649. [PMID: 34065668 PMCID: PMC8156379 DOI: 10.3390/brainsci11050649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
The present study aims to provide detailed observations on the cavernous segment of the abducens nerve (AN), emphasizing anatomical variations and the relationships between the nerve and the internal carotid plexus. A total of 60 sides underwent gross-anatomical study. Five specimens of the AN were stained using Sihler’s method. An additional five specimens were subjected to histological examination. Four types of AN course were observed: a single nerve along its entire course, duplication of the nerve, division into separate rootlets at the point of contact with the cavernous part of the internal carotid artery (ICA), and early-branching before entering the orbit. Due to the relationships between the ICA and internal carotid plexus, the cavernous segment of the AN can be subdivided into a carotid portion located at the point of contact with the posterior vertical segment of the cavernous ICA and a prefissural portion. The carotid portion of the cavernous AN segment is a place of angulation, where the nerve always directly adheres to the ICA. The prefissural portion of the AN, in turn, is the primary site of fiber exchange between the internal carotid plexus and either the AN or the lateral wall of the cavernous sinus.
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Affiliation(s)
- Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland;
- Correspondence:
| | - Maciej Radek
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, University Hospital WAM-CSW, 90-549 Łódź, Poland;
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA; (R.S.T.); (J.I.)
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA 70433, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Anatomical Sciences, St. George’s University, Grenada FZ 818, West Indies
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA; (R.S.T.); (J.I.)
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland;
| | - Piotr Brzeziński
- Department of Histology and Embryology, Chair of Anatomy and Histology, Medical University of Lodz, 90-752 Łódź, Poland;
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland;
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Comparison of the Superior and Inferior Rectus Muscles in Humans: An Anatomical Study with Notes on Morphology, Anatomical Variations, and Intramuscular Innervation Patterns. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9037693. [PMID: 32420380 PMCID: PMC7210515 DOI: 10.1155/2020/9037693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/11/2020] [Indexed: 12/28/2022]
Abstract
A comparison of the superior and inferior rectus muscles was performed to determine whether they have similar structures and innervation attributable to their participation in the same type of, although antagonistic, eye movements. The study was conducted on 70 cadaveric hemiheads, and the anatomical variations in the superior and inferior rectus muscles were assessed. Sihler's whole mount nerve staining technique was used on 20 isolated superior and 20 isolated inferior rectus muscle specimens to visualize the intramuscular distribution of the oculomotor nerve subbranches. In two cases (~2.8%), variant muscular slips were found that connected the superior and inferior rectus muscles. In 80% of cases, muscular branches arising directly from the inferior branch of the oculomotor nerve innervated the inferior rectus muscle, while in 20% of cases, the nerve to the inferior oblique muscle pierced the inferior rectus muscle and provided its innervation. In 15 of 70 specimens (21.4%), a branch to the levator palpebrae superioris muscle pierced the superior rectus muscle. The distance between the specific rectus muscle's insertion and the anterior-most terminations of the nerves' subbranches with reference to the muscle's total length ranged from 26.9% to 47.2% for the inferior rectus and from 34.8% to 46.6% for the superior rectus, respectively. The superior rectus muscle is slightly longer and its insertion is farther from the limbus of the cornea than is the inferior rectus muscle. Both muscles share a common general pattern of intramuscular nerve subbranches' arborization, with characteristic Y-shaped ramifications that form the terminal nerve plexus located near half of the muscles' length. Unexpected anatomical variations of the extraocular muscles may be relevant during orbital imaging or surgical procedures.
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Comparison of lateral and medial rectus muscle in human: an anatomical study with particular emphasis on morphology, intramuscular innervation pattern variations and discussion on clinical significance. Surg Radiol Anat 2020; 42:607-616. [PMID: 31897658 DOI: 10.1007/s00276-019-02400-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
This paper aims to present various aspects of the anatomy of horizontal (i.e., lateral and medial) rectus muscles. It mainly compares morphology and detailed patterns of intramuscular innervation of those muscles. It is also one of the first reports that uses the Sihler's stain to examine human extraocular muscles. The study was conducted on 80 isolated cadaveric hemi-heads. Sihler technique of nerves staining served to expose the course of intramuscular branches of the oculomotor and abducens nerves. The lateral rectus was longer (48 mm versus 46.5 mm) and more distant from the limbus (6.8 mm versus 5.7 mm) than the medial rectus muscle. Three variants of the abducens nerve primary division were observed in the lateral rectus muscle. In the medial rectus muscle, the motor branch from the oculomotor nerve was more evenly divided into sub-branches. In both examined horizontal rectus muscles, primary muscular branches split into secondary sub-branches, which undergo numerous further divisions. The most numerous terminal sub-branches formed the terminal plexus. The distance between the insertion and the anterior-most end of the terminal plexus referenced to the total length of the muscle ranged from 35.4 to 48.5% for the lateral rectus muscle and from 36.3 to 50.5% for medial rectus muscle. Both horizontal rectus muscles share similar general pattern of distribution of intramuscular nerves, with characteristic root-like arborizations of sub-branches. The terminal nerve plexus was observed near half of both muscles' length. Knowledge of variations and innervation pattern of the extraocular muscles may be relevant during ophthalmology surgeries.
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Normal Anatomy and Anomalies of the Rectus Extraocular Muscles in Human: A Review of the Recent Data and Findings. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8909162. [PMID: 31976329 PMCID: PMC6954479 DOI: 10.1155/2019/8909162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/06/2019] [Indexed: 11/17/2022]
Abstract
Development of modern surgical techniques is associated with the need for a thorough knowledge of surgical anatomy and, in the case of ophthalmologic surgery, also functional aspects of extraocular muscles. Thus, the leading idea of this review was to summarize the most recent findings regarding the normal anatomy and anomalies of the extraocular rectus muscles (ERMs). Particular attention was paid to the presentation of detailed and structured data on the gross anatomy of the ERMs, including their attachments, anatomical relationships, vascularization, and innervation. This issue of ERMs innervation was presented in detail, considering the research that has recently been carried out on human material using advanced anatomical techniques such as Sihler's technique of the nerves staining. The text was supplemented with a carefully selected graphic material (including anatomical specimens prepared specially for the purpose of this review) and discussion of the clinical cases and practical significance of the presented issues.
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Anatomical variations of the levator palpebrae superioris, including observations on its innervation and intramuscular nerves' distribution pattern. Ann Anat 2019; 228:151439. [PMID: 31726207 DOI: 10.1016/j.aanat.2019.151439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/06/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The levator palpebrae superioris muscle (LPS) acts as the upper eyelid's major elevator and retractor and is innervated by the oculomotor nerve. The muscle's paralysis is manifested by ptosis. MATERIAL AND METHODS 70 orbits were dissected. After removing the orbital roof, the LPS' shape and anatomical variations (i.e., the presence of accessory muscular bands or atypical formation of the muscle) were assessed. To visualize the distribution of the oculomotor nerve's intramuscular sub-branches, the isolated levator palpebrae superioris muscles were stained using Sihler's staining technique. RESULTS Several LPS anatomical variations were observed in the specimens examined, in seven of which (7/70; 10%) additional delicate muscular slips arose from the LPS' lateral border and reached the lacrimal gland. Histological examination confirmed the presence of striated skeletal muscle fibers in all those cases. In three other specimens (3/70; 4.28%), supernumerary muscular bands ("tensor trochleae") were found that linked the levator with the superior oblique muscle's trochlea. In the next case, the LPS' origin was double and the muscle was bipartite on its proximal half. In most cases (55/70; 78.6%), muscular branches formed a single bundle that wrapped around the superior rectus muscle's medial border to reach the levator's inferior surface. Intramuscular sub-branches were distributed largely within the proximal two-thirds of the LPS and formed an irregular, tree-like pattern. However, thin sub-branches and small retrograde sub-branches extended as far as the muscle's insertion. CONCLUSIONS Plastic surgeons and ophthalmologists should be aware of the levator palpebrae superioris muscle's anatomic variations both in planning and conducting surgeries on the upper eyelid.
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