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

Abstract

IntroductionThe 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.MethodsSihler’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.ResultsAfter 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.DiscussionThe 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.

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

“…Accurate BoNT injection points from an anatomical point of view have been suggested in various studies concerning BoNT injection in specific muscles [ 16 , 17 , 18 , 19 , 20 , 21 , 33 , 34 , 35 , 36 , 37 ]. According to the meta-analysis conducted by Camargo et al, most studies had duration of treatment of 5 months [ 38 ]. Notably, botulinum toxin effects take about two weeks to fully develop and last three to four months.…”

Sihler's staining technique: How to and guidance for botulinum neurotoxin injection in human muscles

“…The intramuscular nerve arborization of the pectoralis major muscle was the largest between the 2/5th and 4/5th portions horizontally, 1/5th and 3/5th portions vertically, 1/5th and 3/5th portions horizontally, and 3/5th and 5/5th portions vertically. These results indicate that the botulinum neurotoxin should be injected into these regions (Figure 12) (Yi, Lee, Kim, & Kim, 2022).…”

A practical guide to botulinum neurotoxin treatment of teres major muscle in shoulder spasticity: Intramuscular neural distribution of teres major muscle in cadaver model

“…The study used the modified Sihler's method to reveal intramuscular nerve patterns in the bilateral muscles of the teres major muscle using nine cadavers (Figure 3). 14,19,20 The muscle samples underwent a multistep process, including a month-long fixation in nonneutral formalin; a month-long treatment with potassium hydroxide and hydrogen peroxide to maceration; 4 weeks of decalcification in a mixture of glycerin, acetic acid; a week of staining with hematoxylin, glycerin; resoaking in the decalcification solution to highlight the nerves; and finally display through immersion in glycerin solutions of increasing concentration (40%, 60%, 80%, and 100%). For more detailed explanations of the procedures see Yi et al 19,20…”