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Anatomical look into OnabotulinumtoxinA injection for chronic migraine headache
Yuewei Wu-Fienberg, MD
Ali Totonchi, MD
University Hospitals Cleveland Medical Center
2017-02-15
Presenter: Yuewei Wu-Fienberg
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Devra Becker
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: While existing studies about BoNT-A for chronic migraines have focused on injection location and appropriate dosing, little consideration has been given to patient body habitus and its potential impact on efficacy. We hypothesized that with increasing patient BMI, there would be more subcutaneous fat separating targeted muscle groups from the skin surface, such that standard 0.5 inch needles used in existing protocols may not allow intramuscular injection. This may have implications for treatment planning.
Methods: Anatomically normal CT scans of the head, neck, and face were randomly selected. Subjects were stratified into four groups based on BMI, with five patients in each group. Four standardized locations were chosen to obtain measurements from the skin surface to the underlying muscle fascia, including (1) frontalis, (2) temporalis, (3) semispinalis capitis) and (4) trapezius.
Results: Average depths for the temporalis was 13.49 ± 2.63mm for the BMI > 35 group. Average depths for the semispinalis capitis were 15.42 ± 4.67mm for the BMI 25 - 30 group, 15.90 ± 5.13mm for the BMI 30 -35 group, and 19.43 ± 3.86mm for the BMI > 35 group. These averages exceeded the length of the standard 0.5 inch (12.70mm) needle used in existing protocols.
Conclusions: Our study demonstrates that, with increasing BMI, there is a greater distance between the skin surface and the muscle fascia of muscles that are targeted for injection in standard chronic migraine botulinum toxin injection protocols. Because of this, patient body habitus may be an important factor in injection technique.
