Trap Tox; Botox Injection Technique Into the Trapezius Muscles

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What is Trap Tox or Trapezius Tox?


Trap Tox or Trapezius Tox is another cosmetic use for botulinum toxin. Injecting botulinum toxin into the trapezius muscle, at the upper border of the trapezius, can create a smooth shoulder line for their dress as a result of neurogenic atrophy. Muscle mass loss can create the effects of a slimmer and longer neck appearance. 


Purpose


Botulinum toxin injections in the trapezius muscle are primarily indicated for the treatment of chronic muscle tension, spasms, and pain. This application is particularly beneficial for patients with myofascial pain syndrome and chronic tension-type headaches originating from the trapezius muscle. The efficacy of botulinum toxin in reducing pain and improving muscle function has been substantiated in several studies. 


Anatomy


The trapezius muscle, a large, triangular muscle extending over the back of the neck and shoulders, plays a crucial role in moving, rotating, and stabilizing the scapula and extending the neck. No major blood vessel along the superficial trapezius muscle.


The accessory nerve travels caudally along the inferior surface of the trapezius muscle, after piercing its anterior border.


Landmark


Identifying anatomical landmarks is crucial for effective botulinum toxin injection. Based on research, the landmarks should be placed like this:



The injection technique involves using a fine needle to inject botulinum toxin into the trapezius muscle. The procedure should be performed under sterile conditions. The number of injection points can vary, but they are generally evenly distributed over the muscle. Accurate needle placement is crucial to maximize efficacy and minimize side effects.


This is an example of an Alternative Injection Landmark


This researcher recommended that the injector avoid injecting medial to the most lateral point of the external occipital protuberance line, which extends from the occipital bone down to the trapezius muscle. This prevents toxin spread to muscles affecting breathing or swallowing. 


Trap Tox or Trapezius Tox Dosage Guide


Dosage from research studies by Allergan: Ranges From 10 to 50 units with 1-5 injection sites.


Injection for Trapezius muscle for Botox Therapeutic for chronic migraine: 5U per site, 3 injection sites per side, total of 15U per side or 30U for both right and left sides.


Injection for Trapezius muscle for Botox Therapeutic for cervical dystonia: mean dose of 68U for both right and left sides. 


Starting dosage should begin with 5 units per injection site, with 3-6 sites per side (15-30 units per side) in sections B & C, and titrate up as needed.


Side Effects


Common side effects include:


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