Transversus nuchae muscle fused with risorius muscle: a case report / Músculo transverso de la nuca fusionado con músculo risorius: informe de un caso

SUMMARY: Facial muscles are known to have a variable anatomy. Such anatomical variations can affect facial expressions. A natural smile is produced by contracting several muscles of facial expression, including the muscles invested in the superficial musculoaponeurotic system. Change in the width of the mouth on smiling is a known iatrogenic complication affecting the risorius muscle when using Botulinum Neurotoxin as a non-invasive treatment for masseteric hypertrophy. Also damage to the risorius muscle, with consequent clinical deficits, is a common surgical complication in facial aesthetic, oncologic and other head and neck procedures such as parotidectomy and rhytidectomy. Hence, a thorough knowledge of muscle anatomy, particularly its potential variations, is critical in reducing the associated operative morbidity. Accordingly, we report an unusual variation of the transversus nuchal muscle fused with the risorius muscle noted in an 83-year-old female body cadaver.

RESUMEN: Los músculos faciales tienen una anatomía variable. Tales variaciones anatómicas pueden afectar las expresiones faciales. Una sonrisa natural se produce al contraer varios músculos de la expresión facial, incluidos los músculos invertidos en el sistema musculoaponeurótico superficial. El cambio en el ancho de la boca al sonreír es una complicación iatrogénica conocida, que afecta el músculo risorio cuando se usa la neurotoxina botulínica como un tratamiento no invasivo para la hipertrofia masterérica. Además, el daño al músculo risorio, con los consecuentes déficits clínicos, es una complicación quirúrgica común en la estética facial, oncológica y otros procedimientos de cabeza y cuello, como la parotidectomía y la ritidectomía. Por lo tanto, un conocimiento profundo de la anatomía muscular, particularmente sus posibles variaciones, es crítico para reducir la morbilidad operativa asociada. En consecuencia, informamos una variación inusual del músculo transverso de la nuca fusionado con el músculo risorio, observado en un cadáver de cuerpo femenino de 83 años.

Location of the Modiolous and the Morphologic Variations of the Risorius and Zygomaticus Major Muscle Related to the Facial Expression in Koreans / 체질인류학회지

Location of the modiolous and morphological variations of the risorius and zygomaticus major muscles are related to the facial expression. The zygomaticus major, levator labii superioris, depressor labii inferioris, depressor anguli oris, risorius, orbicularis oris, buccinator and levator anguli oris muscles insert on the lateral border of the lip, forming the modiolus and mutually associating each other for functioning. The knowledge of the location of the modiolus and surrounding structures are essential to anatomy, prosthodontics, linguistic, physiology and computer simulation based on facial expressions. The authors examined the location of the modiolus, the morphological variations and anatomical relationship of risorius and zygomaticus major muscle to understand the features of the smile of Korean by dissecting 39 cadavers. The location of the modiolus can be showed as three types, according to their height related to the intercheilion horizontal line. Type A that modiolus locate at the intercheilion line was shown in 20 sides (26.0%), type B that modiolus locate above the intercheilion line was shown in 12 sides (15.6%), then type C that modiolus locate under the intercheilion line was shown in 45 sides (58.4%). Most modioli located at 10 ~20 mm lateral to the mouth corner and 0 ~10 mm below the intercheilion line. The risorius muscle was classified into five types by directions of muscle fibers. The depressor anguli oris -risorius type (type I) was observed in 31 sides (40.2%), the platisma -risorius type (type II) was observed in 30 sides (39.0%). Previously, it has been known that zygomaticus major muscle attaches to the modiolus mainly as one bundle. However, the results were clearly shown that two bundles of the zygomaticus major muscle attaches to the modiolus and the position of the mouth edge in 18 sides (23.4%). To sum it up, facial expression is of fundamental importance concerning the morphological variations and these results also can be considered for the facial reconstruction surgery and computer animation department.