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Review
. 2024 Mar;37(2):169-177.
doi: 10.1002/ca.24076. Epub 2023 May 31.

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

Kyu-Ho Yi  1   2 , Hyewon Hu  1 , Ji-Hyun Lee  3 , Min Ho An  4 , Hyung-Jin Lee  5 , You-Jin Choi  6 , Hee-Jin Kim  7
Affiliations
Review

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

Kyu-Ho Yi et al. Clin Anat. 2024 Mar.

Abstract

The Sihler's stain is a whole-mount nerve staining technique that allows visualization of the nerve distribution and permits mapping of the entire nerve supply patterns of the organs, skeletal muscles, mucosa, skin, and other structures that contain myelinated nerve fibers. Unlike conventional approaches, this technique does not require extensive dissection or slide preparation. To date, the Sihler's stain is the best tool for demonstrating the precise intramuscular branching and distribution patterns of skeletal muscles. The intramuscular neural distribution is used as a guidance tool for the application of botulinum neurotoxin injections. In this review, we have identified and summarized the ideal botulinum neurotoxin injection points for several human tissues.

Keywords: Sihler's staining; botulinum neurotoxin; intramuscular neural distribution; skeletal muscle.

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REFERENCES

    1. Choi, Y. J., Cho, T. H., Won, S. Y., & Yang, H. M. (2020). Guideline for botulinum toxin injections in the effective treatment of fibular spasticity. Clinical Anatomy, 33, 365-369.
    1. Choi, Y. J., Lee, W. J., Lee, H. J., Lee, K. W., Kim, H. J., & Hu, K. S. (2016). Effective botulinum toxin injection guide for treatment of temporal headache. Toxins (Basel), 8, 265.
    1. Kim, D. H., Hong, H. S., Won, S. Y., Kim, H. J., Hu, K. S., Choi, J. H., & Kim, H. J. (2010). Intramuscular nerve distribution of the masseter muscle as a basis for botulinum toxin injection. The Journal of Craniofacial Surgery, 21, 588-591.
    1. Lee, H. J., Lee, J. H., Yi, K. H., & Kim, H. J. (2022b). Intramuscular innervation of the supraspinatus muscle assessed using Sihlers staining: Potential application in myofascial pain syndrome. Toxins (Basel), 14, 14.
    1. Lee, H.-J., Lee, J.-H., Yi, K.-H., & Kim, H.-J. (2022a). Sonoanatomy and an ultrasound scanning protocol of the intramuscular innervation pattern of the infraspinatus muscle. Regional Anesthesia & Pain Medicine Medicine:rapm-2022, 48, 175-179.

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