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Anatomy of the Corrugator Superciliii Muscle

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Anatomy of the Corrugator Superciliii Muscle COSMETIC Anatomy of the Corrugator Supercilii Muscle: Part I. Corrugator Topography Jeffrey E. Janis, M.D. Background: Complete corrugator supercilii muscle resection is important for Ashkan Ghavami, M.D. the surgical treatment of migraine headaches and may help prevent postoper- Joshua A. Lemmon, M.D. 06/02/2021 on SlonBoPBttLBlesWK19Dk2zjhqEF20t9hZgFb4/+nucVgezvuhWCN7eWJVnDJyyJ2HOJuX0FknxIrnIziRU2QFO8LXAcJprnl0EqdSCPJ9lhdCqBrdvVGtsD7qyoTO6/ by http://journals.lww.com/plasreconsurg from Downloaded ative abnormalities in surgical forehead rejuvenation. Specific topographic anal- Jason E. Leedy, M.D. ysis of corrugator supercilii muscle dimensions and its detailed association with Bahman Guyuron, M.D. Downloaded the supraorbital nerve branching patterns has not been thoroughly delineated. Dallas, Texas; and Cleveland, Ohio Part I of this two-part study aims to define corrugator supercilii muscle topog- from raphy with respect to external bony landmarks. http://journals.lww.com/plasreconsurg Methods: Twenty-five fresh cadaver heads (50 corrugator supercilii muscles and 50 supraorbital nerves) were dissected to isolate the corrugator supercilii muscle from surrounding muscles. Standardized measurements of corruga- tor supercilii muscle dimensions were taken with respect to the nasion and lateral orbital rim. Results: Relative to the nasion, the most medial origin of the corrugator by supercilii muscle was found at 2.9 Ϯ 1.0 mm; the most lateral origin point, SlonBoPBttLBlesWK19Dk2zjhqEF20t9hZgFb4/+nucVgezvuhWCN7eWJVnDJyyJ2HOJuX0FknxIrnIziRU2QFO8LXAcJprnl0EqdSCPJ9lhdCqBrdvVGtsD7qyoTO6/ 14.0 Ϯ 2.8 mm. The lateralmost insertion of the corrugator supercilii muscle measured 43.3 Ϯ 2.9 mm from the nasion or 7.6 Ϯ 2.7 mm medial to the lateral orbital rim. The most cephalic extent (apex) of the muscle was located 32.6 Ϯ 3.1 mm cephalad to the nasion–lateral orbital rim plane and 18.0 Ϯ 3.7 mm medial to the lateral orbital rim. There were no statistical differences noted between the right and left sides. Conclusions: The dimensions of the corrugator supercilii muscle are more extensive than previously described and can be easily delineated using fixed bony landmarks. These data may prove beneficial in performing safe, com- plete, and symmetric corrugator supercilii muscle resection for forehead rejuvenation and for effective decompression of the supraorbital nerve and supratrochlear nerve branches in the surgical treatment of migraine headaches. (Plast. Reconstr. Surg. 120: 1647, 2007.) omplete resection of the corrugator super- tence of dynamic rhytides.1–3 All of these may cilii muscle has been advocated for both become exaggerated on forehead animation.1,4,5 forehead rejuvenation and in the surgical The cause of this may be related to the surgical C 1–3 treatment of migraine headaches. Unequal approach, specific technical execution, and/or corrugator supercilii muscle removal and/or in- the surgeon’s experience with a particular complete corrugator supercilii muscle resection technique.1,6,7 after forehead rejuvenation can lead to undesir- In a recent study, Walden et al.6 have shown that able sequelae such as dimpling, depressions, and the amount of corrugator supercilii muscle resec- on residual corrugator activity, with resultant persis- tion can vary depending on the approach used, 06/02/2021 with as much as one-third of the transverse corru- From the Department of Plastic Surgery, The University of gator supercilii muscle head remaining after trans- Texas Southwestern Medical Center, and the Department of palpebral attempts at complete muscle removal. Plastic and Reconstructive Surgery, Case Western Reserve Although the senior author (B.G.) believes that University School of Medicine. 7,8 Received for publication April 13, 2006; accepted September this may largely be technique-related, familiarity 7, 2006. with normal corrugator supercilii muscle dimen- Gaspar W. Anastasi Award presentation at the American sions in reference to fixed bony landmarks can Society for Aesthetic Plastic Surgery Annual Meeting, in minimize this unpredictability and allow for a Orlando, Florida, April 23, 2006. more systematic approach to precise corrugator Copyright ©2007 by the American Society of Plastic Surgeons supercilii muscle myectomy. In addition, a compre- DOI: 10.1097/01.prs.0000282725.61640.e1 hensive understanding of the corrugator supercilii www.PRSJournal.com 1647 Plastic and Reconstructive Surgery • November 2007 muscle dimensions may assist less experienced sur- while interdigitating with the orbicularis oculi geons in obtaining a successful outcome when per- muscle and frontalis muscles. The oblique head of forming any of the numerous surgical approaches the corrugator supercilii muscle is smaller, with its for forehead rejuvenation that have been de- fibers commonly running parallel to those of the scribed. depressor supercilii muscle after insertion into the Migraine headaches have been postulated to be medial brow. associated with peripheral nerve trigger points.9–14 Knize15 dissected 40 hemifacial cadaver heads The supraorbital/supratrochlear nerves have been to evaluate the detailed muscular anatomy of the implicated as one of four peripheral trigger sites forehead region. The origin of the corrugator su- that potentially account for migraine headache percilii muscle was found to be consistent and symptomatology.10 Improvement or complete located at the frontal bone near the superomedial amelioration of migraine headaches has been orbital rim, anterior and slightly cephalad to the demonstrated after chemodenervation of the cor- trochlea of the extraocular superior oblique rugator supercilii muscle by botulinum toxin type muscle.15 The corrugator supercilii muscle fibers A,9,10 which is theorized to act by decompression of then pass superolaterally “through” the frontalis the supraorbital nerve and supratrochlear nerve by and orbicularis oculi muscles before inserting into relaxation of the investing musculature.10,14 Long- the medial half of brow skin.15 The corrugator term success has been demonstrated in a vast ma- supercilii muscle also extends through the galeal jority of patients who have subsequently gone on to fat pad before giving off its dermal insertions.15 It have complete corrugator supercilii muscle is unclear from these and other descriptions myectomy.10 whether the corrugator supercilii muscle extends Based on extensive intraoperative observation, beyond the temporal fusion line, and exactly how the senior author (B.G.) postulates that the su- lateral the insertion point is.16,17 praorbital nerve branches demonstrate a more In a recent report that examined the efficacy significant investment pattern in relation to the of the transpalpebral, endoscopic, and open coro- corrugator supercilii muscle fibers, further sup- nal approaches to corrugator supercilii muscle re- porting the necessity for safe and complete re- section, the transverse head of the corrugator su- section of the corrugator supercilii muscle for percilii muscle was found to be incompletely supraorbital nerve decompression in migraine resected, mostly in the lateral region using the treatment. Although the investing topography of transpalpebral approach.6 The authors noted that other peripheral trigger points has been the transverse head of the corrugator muscle was described,9,11–13 the supraorbital nerve and its longer and thicker (average, 7.5 mm) than the close relationship to the corrugator supercilii oblique head (2.0 mm).6 More complete resection muscle fibers requires further anatomical inspec- of the corrugator, along with the depressor super- tion. A comprehensive understanding of corru- cilii and procerus muscles, was seen with the en- gator supercilii muscle dimensions and its rela- doscopic approach. In addition, the authors noted tionship with the supraorbital nerve branching the utility of visual cues such as muscle color to patterns may improve the safety and predictabil- differentiate between the various muscle fibers.6 ity of forehead rejuvenation and surgical treat- For example, the medial orbicularis oculi is su- ment for migraine headaches. In Part I of this perficial and a lighter pink than the vertically ori- study, the topographic dimensions of the corru- ented red depressor supercilii muscle fibers.6 Isse gator supercilii muscle with respect to fixed ex- and Elahi17 performed a smaller cadaver study and ternal bony landmarks are defined, whereas in found that in the lateral two-thirds of the brow, the Part II, the branching patterns of the supraor- corrugator supercilii muscle fibers pass through the bital nerve as they relate to the corrugator super- orbicularis oculi and frontalis muscles. This most cilii muscle fibers are described. lateral region of the corrugator supercilii muscle, although difficult to dissect, is important because RELEVANT ANATOMY it may largely account for lateral brow depressions The corrugator supercilii muscle is one of the seen postoperatively.17,18 three commonly described brow depressor muscle The motor nerve supply to the corrugator groups (including the medial orbicularis oculi supercilii muscle is from the frontal branch of and depressor supercilii) and is composed of two the temporal division of the facial nerve, heads. The transverse head originates from the whereas the zygomatic branch seems to inner- superomedial aspect of the orbital rim to insert vate the oblique head.2 Postoperative observation into the dermis at the middle third of the brow of corrugator supercilii muscle reactivation
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