Keywords
platysma muscle rupture - vigorous facial massage - mass-like lesion
Introduction
Blunt neck traumas only account for approximately 5% of all neck traumas[1] and are most commonly caused by motor vehicle collisions.[2] Only one case of platysma muscle rupture has been reported in the literature. Muscular
injuries are often associated with complications or recurrences.[3] These complications depend on the type of injury and are categorized as early, intermediate,
or delayed. Muscle rupture usually occurs in sports and develops at the extremities,
such as in the rectus femoris muscle,[4] gastrocnemius muscle,[5] or pectoralis major muscle.[6] However, there have been no case reports of facial muscle rupture due to continuous
severe stimulation. Herein, we report a case of unilateral platysma muscle rupture
caused by facial massage.
Case
A 63-year-old woman visited our clinic with facial asymmetry and a mass-like lesion
on the right lower face, which had grown since she first noticed it 2 months before
([Fig. 1A–C]). The patient received facial massages using a hard wooden block designed for facial
massage twice a day for a year. She had no history of surgery or other procedures
such as injection of botulinum toxin or fillers or thread lifting. The patient desired
removal of the mass for facial symmetry and a bilateral facial lift.
Fig. 1 A 63-year-old woman with facial asymmetry and a mass-like lesion on the right lower
face, which had grown since she first noticed it 2 months before. (A) Preoperative frontal view. Mass-like lesion noticed (red dotted circle). (B) Preoperative right lateral view. Mass-like lesion noticed (red dotted circle). (C) Preoperative left lateral view. (D) Postoperative 2 weeks frontal view. (E) Postoperative 2 weeks right lateral view. (F) Postoperative 2 weeks left lateral view.
Physical examination revealed a 2 cm × 2 cm movable soft tissue mass, which moved
downward during mastication. The mass was located in the subcutaneous layer and could
be removed via a conventional face lift operation.
The patient was prepared for a conventional facelift with tumescent infiltration (2%
lidocaine and 1 mL of 1:100,000 epinephrine) into the facial subcutaneous plane. The
incision started from the hairline, extended vertically along the anterior helical
sulcus and post-tragally, and ended in the postauricular area. An incision was made
in the subcutaneous layer, and the superficial musculoaponeurotic system (SMAS) was
exposed. Intraoperatively, the platysma muscle was found to be ruptured near Lore's
fascia and had collapsed to form a lump at the border of the mandible ([Fig. 2]). The platysma was elevated as a muscle flap, and a fully released masseteric retaining
ligament was used for the repair. The end of the muscle was sutured near Lore's fascia
using size 3–0 vicryl sutures to maintain muscle tension. An extended SMAS dissection
was also performed and elevated in the superolateral direction. Skin flap redraping
was performed, and the remnant skin was excised. Skin closure was performed using
size 6–0 nylon sutures. No mass-like structure was detected postoperatively. Postoperative
2 weeks' photographs were taken ([Fig. 1D–F]). The patient provided written informed consent.
Fig. 2 Intraoperatively, the platysma muscle was found to be ruptured near Lore's fascia
and had collapsed to form a lump at the border of the mandible.
Discussion
We presented a case of platysma muscle rupture caused by facial massage. The platysma
muscle attaches to the lower border of the mandible and mandibular septum and merges
with the facial muscles around the lower lip. It originates from the upper portion
of the thorax anterior to the clavicle at the subcutaneous tissue of the subclavicular
region and the pectoralis. The lymphatics of the anterior neck lie above the platysma
muscle, and manual lymphatic drainage can be performed to reduce edema and pain as
well as enhance the range of motion and patients' quality of life.[7] Many people undergo facial massages to feel fresh and rejuvenated, tighten the skin,
and delay the onset of wrinkles.[8] Meridian facial massages are commonly performed in Korea for skin rejuvenation and
facial lifting and to decrease the face size.[9] Several people undergo these procedures although their effectiveness has not been
scientifically proven. In our case, the patient had used a hard wooden block for facial
massage for a year. The use of gua sha and jade rollers originates from ancient China.[10] Their use can stimulate a powerful facial massage but cause complications. To the
best of our knowledge, this is the first reported case of platysma muscle rupture
caused by frequent facial massages.
Vigorous facial massage can induce platysma muscle rupture, although this is rare.
We report a case of unilateral platysma muscle rupture caused by facial massage. It
is necessary to further investigate this unique etiology and implement appropriate
muscle sutures based on the intraoperative findings.
