Anatomical and radiological evaluation of modiolus anguli oris in facial anatomy



Modiolus, Magnetic resonance imaging, Radiologic anatomy, Senile changes, Aging


Aim: Modiolus is a dense, mobile fibromuscular structure lateral to the mouth corner. It is of great importance in aesthetic and reconstructive surgery. The aim of this study was to enlighten the structural changes in modiolus with demographic variables such as age and gender in living individuals.

Methods: This retrospective cohort study was conducted on MR images of healthy individuals. Age and sex-related changes in modiolus level and volume were retrospectively analyzed in 64 patients [37M; 27F; mean age 48.2(16.3)] who underwent head and neck magnetic resonance imaging. ROC analysis was performed to determine the cut off values for age of modiolus. Correlation analysis (Pearson and point biserial correlation) was used to determine whether there was a significant correlation between age and volume. Significance of the differences between the volumes of right and left modiolus of the same individual were evaluated by dependent t tests.

Results: The mean volume of the modiolus was calculated as 0.51(0.26) mm3. The volumes of right and left modioli decreased by aging. Ninety-one percent of the patients with modioli located inferior to horizontal line were over 49 years old. Right and left modioli relocated inferior to horizontal line with age. Modiolus volume was prominently less in women and the downward displacement of modiolus in women was 3.3 times higher than in men. Gender and age had significant effects on modiolus level. The right and left modiolus volumes were similar (P=0.975).

Conclusion: Surgeon’s knowledge on modiolus and its relations will provide benefit, not only for the procedures such as face lifting and botulinum toxin injection, but also for the surgeries of facial paralysis and trauma patients.


Download data is not yet available.


Kim HS, Pae C, Bae JH, Hu KS, Chang BM, Tansatit T, et al. An anatomical study of the risorius in Asians and its insertion at the modiolus. Surg Radiol Anat. 2015;37(2):147-51.

Yu SK, Lee MH, Kim HS, Park JT, Kim HJ, Kim HJ. Histomorphologic approach for the modiolus with reference to reconstructive and aesthetic surgery. J Craniofac Surg. 2013;24(4):1414-7.

Zufferey JA. Importance of the modiolus in plastic surgery. Plast Reconstr Surg. 2002;110(1):331-4.

Al-Hoqail RA, Abdel Meguid EM. An anatomical and analytical study of the modiolus: enlightening its relevance to plastic surgery. Aesthetic Plast Surg. 2009;33(2):147-52.

Onderoğlu S. Topographical relations of the facial artery in the region of the modiolus anguli oris. Okajimas Folia Anat Jpn. 1999;76(2-3):141-7.

Ahn HJ, Ho-Jung Cho HJ, Nam YS, Han SH, Chung IH, Kim IB. The Location of the Modiolus in Living Korean. Korean J Phys Anthropol. 2009;26(4):141-6.

Zufferey JA. Modiolus: dynamic angular stone of the nasolabial fold. Eur J Plast Surg. 2003;25:352–6.

Marinetti CJ. The lower muscular balance of the face used to lift labial commissures. Plast Reconstr Surg. 1999;104(4):1153-62.

Demiryurek D, Bayramoglu A, Erbil KM. Three-dimensional structure of the modiolus. A computerized reconstruction study. Saudi Med J. 2003;24:846-9.

Standring S. Gray’s anatomy: the anatomical basis of clinical practice, Churchill Livingstone Spain: Elsevier;2008. p.495-498.

Choi YJ, Kim JS, Gil YC, Phetudom T, Kim HJ, Tansatit T, et al. Anatomical considerations regarding the location and boundary of the depressor anguli oris muscle with reference to toxin injection. Plast Reconstr Surg. 2014;134(5):917-21.

Brandt F, Bassichis B, Bassichis M, O'Connell C, Lin X. Safety and effectiveness of small and large gel-particle hyaluronic acid in the correction of perioral wrinkles. J Drugs Dermatol. 2011;10(9):982-7.

Kwak HH, Hu KS, Youn KH, Jin GC, Shim KS, Fontaine C, et al. Topographic relationship between the muscle bands of the zygomaticus major muscle and the facial artery. Surg Radiol Anat. 2006;28:477-80.

Otero_Rivas MM, Alonso-Alonso T, Perez-Bustillo A, Rodriguez-Prieto MA. Reconstruction of Surgical Defects of the Labial Commissure. Actas Dermosifiliogr. 2015;106(9):49-54.

Robotti E, Righi B, Carminati M, Ortelli L, Bonfirraro PP, Devalle L, et al. Oral commissure reconstruction with orbicularis oris elastic musculomucosal flaps. J Plast Reconstr Aesthet Surg. 2010;63:431-9.






Research Article

How to Cite

Çalışkan S, Çelebioğlu EC, Akkaşoğlu S, Günenç Beşer C, Sargon MF. Anatomical and radiological evaluation of modiolus anguli oris in facial anatomy. J Surg Med [Internet]. 2019 Sep. 1 [cited 2022 Dec. 7];3(9):694-7. Available from: