Surg Radiol Anat (2015) 37:147–151

DOI 10.1007/s00276-014-1330-6

ORIGINAL ARTICLE

An anatomical study of the risorius in Asians and its insertion

at the modiolus
Hong‑San Kim · Calvin Pae · Jung‑Hee Bae ·
Kyung‑Seok Hu · Brian M. Chang · Tanvaa Tansatit ·
Hee‑Jin Kim 

Received: 26 December 2013 / Accepted: 12 June 2014 / Published online: 27 June 2014
© Springer-Verlag France 2014

Abstract  depressor anguli oris: superficial, flush, and deep. Superfi-

Purpose  Detailed explanations of the insertion, interac-
tion patterns, and arrangement of the risorius muscle fibers
at the modiolus have still not been clearly shown. The aim
of this study is to clarify the arrangement of the risorius
muscle by means of topographic examination, and to evalu-
ate the anatomical variations in its attachments and pattern
of shape to other perioral muscles, and eventually to under-
stand the various features of the facial animation of Asians.
Materials and methods  Eighty embalmed Korean and
Thai adult hemifaces from cadavers of both genders were
dissected in this study. Detailed dissection at the modiolus
revealed the insertion of the risorius muscle in relation to
its attachments and fiber interaction forms.
Results  When categorized into three common anatomical
types—zygomaticus risorius (ZR), platysma risorius (PR),
and triangularis risorius (TR). PR was most common with
45 % (36 cases) frequency. Risorius muscle also inserted
into the modiolus in three distinct layers in relation to the
H.-S. Kim and C. Pae contributed equally to this work.
H.-S. Kim · J.-H. Bae · K.-S. Hu · H.-J. Kim (*)  grinning, laughing, or smiling muscle [5].
Division in Anatomy and Developmental Biology, Department
of Oral Biology, Human Identification Research Center, BK21
PLUS Project, Yonsei University College of Dentistry, Seoul,
South Korea
e-mail: hjk776@yuhs.ac
C. Pae · B. M. Chang 
Department of Restorative Dentistry and Biomaterials Sciences,
Harvard School of Dental Medicine, Boston, MA, USA
T. Tansatit 
The Chula Soft Cadaver Surgical Training Center
and Department of Anatomy, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand
cial attachment was most commonly found with 56.3 % (45
cases) frequency.
Conclusions  These results will provide critical informa-
tion for future planning and performing of reconstructive,
reanimation, and cosmetic surgical procedures for cases
such as developmental defect, facial trauma, facial muscle
paralysis, and restoring the natural personal appearances.
Keywords  Risorius muscle · Modiolus · Platysma
risorius · Zygomaticus risorius · Triangularis risorius
Introduction
The risorius muscle is highly variable in size ranging from
small and slender to being a broadly set muscle pulling
superolaterally on the corner of the mouth during many
facial expressions [4, 7]. It originates in the superficial fas-
cia above the masseter muscle and attaches to the central
tendon region known as the modiolus [5]. When the modio-
lus contracts, it retracts and elevates the labial commissure
to widen the oral fissure and has been referred to as the
The anatomical arrangement and the interlacing of the
risorius musculature with other perioral muscles have been
studied extensively from the past. In Lightoller’s 1925 arti-
cle published in the Journal of Anatomy, he described riso-
rius as a third head of the depressor anguli oris (DAO) or
then called, triangularis muscle. He also stated that it origi-
nated from the fascia of the cheek either the fibrous tissue
over platysma or even parotid gland, or from panniculus
adiposus [11]. It articulates that risorius muscle lies any-
where in compass between DAO and zygomaticus muscle
and that risorius muscle is not a mere muscle of laughter

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148
but muscle frequently used in speaking and controlling
orbicularis oris collaboratively with other perioral struc-
tures. It also suggests that the risorius muscle can be fur-
ther classified in different types, such as platysma risorius
and triangularis risorius, the latter being more common and
thus speculating that risorius muscle is part of DAO.
In reconstructive surgery of the face using myocutane-
ous, fasciocutaneous, or isolated flap correct isolation and
differentiation of mimetic muscle layers require special
attention [14]. The risorius muscle is represented in the sec-
ond layer of the facial muscles along with platysma, zygo-
maticus major, deeper portion of the zygomaticus minor,
and the levator labii superioris alaeque nasi [6]. Superficial
to this layer lies the first layer: the DAO and the superficial
part of the zygomaticus minor.
Risorius muscle is seen to run toward the angle of the
mouth which forms the modiolus together with the DAO,
zygomaticus major, the orbicularis oris, buccinators, and
the levator anguli oris [16]. Modiolus, lateral to the lip
commissure, is a musculotendinous structure made up
of risorius, zygomaticus major and minor, and DAO, and
is noted to be comprised of thin muscle fibers profoundly
interdigitated making it very difficult to isolate [3].
Although the anatomical and functional aspects of the
risorius in respect to perioral musculatures have been well
demonstrated in literature and textbooks, detailed explana-
tions of the insertion and interaction patterns, and arrange-
ment of the risorius muscle fibers have still not been clearly
shown.
Therefore, the aim of this study is to clarify the arrange-
ment of the risorius muscle by means of topographic exam-
ination, and to evaluate the anatomical variations in its
attachments and pattern of shape to other perioral muscles,
such as DAO and orbicularis oris muscle, and eventually
to understand the various features of the facial animation
of Asians. We hypothesize that there are clinically valu-
able information regarding the shape, layer, and trends of
the muscle fiber interactions between risorius and perioral
muscles that could be categorized and be further general-
ized. Close examination and verification of this muscle
structure in regards with its interactions to other facial mus-
cles will provide critical information to the surgeons and
other experts in the field for future planning of reconstruc-
tive, reanimation, and aesthetic surgical procedures.
Materials and methods
Eighty embalmed Korean and Thai adult hemifaces from
cadavers of both genders (60 Koreans and 20 Thai, 44
males and 36 females, average age of 68) were dissected
in this study. The skin and subcutaneous tissue of the
face were carefully removed from the lower eyelid to the
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Surg Radiol Anat (2015) 37:147–151
inferior margin of the mandible. Using a surgical micro-
scope (OPMI pico; Carl Zeiss, Germany), detailed dis-
section was performed to differentiate the perioral mus-
cles according to different layers, and not to damage any
underlying musculature, nerves, and blood vessels. Spe-
cial attention was paid to the risorius muscle to refine its
course, form of pattern, and the attachment to other perioral
muscles. The interactions of the risorius muscle fibers with
orbicularis oris, levator labii superioris, levator anguli oris,
zygomaticus major, zygomaticus minor, buccinator, DAO,
depressor labii inferioris, mentalis, and platysma muscle
were greatly emphasized.
The dissection took place at each layer of the perioral
muscle bilaterally and photos were taken for each sample.
Based on close topographic examination, the anatomical
variations of the risorius muscle at the layer of insertion in
the modiolus, and the forms of its main courses were gath-
ered. The course of the risorius muscle inserting into the
modiolus were categorized into three types depending on
the vector at major risorius muscle fiber insertion; zygo-
maticus risorius (ZR), platysma risorius (PR), and trian-
gularis risorius (TR). The name implies close relationship
with the corresponding muscles—zygomaticus, platysma,
and DAO along the course of insertion from above, along,
and below in reference to intercheilion horizontal line to
the modiolus, respectively (Fig. 1). The layer at which the
risorius muscle inserted at the modiolus was also classified
in three types—superficial, flush, and deep in reference to
DAO (Fig. 2). The information was assembled into a large
database and statistical significance was analyzed using
Chi square test depending on layer of attachment, insertion
pattern, and gender.
Results
In this study, the 80 hemifacial samples were used. Origi-
nally, 82 hemifaces were dissected but risorius was absent
in two samples. The most frequently observed risorius mus-
cle type was PR with frequency of 45 % (36 cases), TR was
second most found with 35 % (28 cases) frequency, and
ZR was the least common 20 % (16 cases). In the males
group (44 cases), the risorius type was found PR 40.9 %
(18 cases), TR 31.8 % (14 cases), ZR 27.3 % (12 cases)
and in the females group (36 cases), PR was found 50 %
(18 cases), TR 38.9 % (14 cases), and ZR 11.1 % (4 cases)
were observed, respectively.
In terms of the attachment level of the risorius muscle
at the modiolus in reference to DAO muscle, risorius mus-
cle most commonly attached superficially with 56.3 % (45
cases). It also attached flush and deep to DAO with 31.2 %
(25 cases) and 12.5 % (10 cases) of frequency, respectively.
These results were classified in risorius muscle attachment
Surg Radiol Anat (2015) 37:147–151 149

Fig. 1  Three patterns of the risorius based on the presence and the Fig. 2  Morphological classification of the risorius attachment layer.
course of the muscle fiber. a Platysma risorius b triangularis risorius Photography of dissected hemiface and its corresponding schematic
c zygomaticus risorius; Zmj zygomaticus major, Zmi zygomaticus illustration showing different risorius muscle attachment layers at the
minor, OOr orbicularis oris, LAO levator anguli oris, DAO depressor modiolus in reference to depressor anguli oris fiber: a insertion of
anguli oris, Bucc buccinators, DLI depressor labii inferioris superficial layer b insertion of flush layer c insertion of deep layer;
Zmj zygomaticus major, OOr orbicularis oris, LAO levator anguli
oris, DAO depressor anguli oris, DLI depressor labii inferioris
levels at the modiolus depending on gender. In males, the
risorius muscle inserted to modiolus mostly at superficial
layer 68.2 % (30 cases), then deep 20.4 % (9 cases), and Table 1  Frequency of muscle attachment layer in 80 hemifaces strat-
flush 11.4 % (5 cases). Whereas, the risorius attached at ified by gender
flush plane most 55.5 % (20 cases), then superficial 41.7 % Male Female *P value
(15 cases), and deep 2.8 % (1 case) in females (Table 1).
Superficial 30 (68.2 %) 15 (41.7 %) 0.001
There was no statistically significance among the gender
Flush 5 (11.4 %) 20 (55.5 %)
and muscle attachment (p > 0.05).
Deep 9 (20.4 %) 1 (2.8 %)
The relationship between the type of risorius muscle and
Sum 44 36
its attachment also rendered important correlations. In PR
type (36 cases), superficial attachment was most frequently * P value was obtained by Chi square test
found in 17 cases (47.2 %), but flush level was second most
common in 13 cases (36.1 %) and then deep in 6 cases
(16.7 %). In TR type (28 cases), however, there was no Discussion
deep attachment and only superficial in 20 cases (72.4 %)
and flush in 8 cases (28.6 %) attachments were observed. The present study provides critical information in under-
ZR type (16 cases) attached superficially in 8 cases (50 %) standing the structure of the risorius in specific, and its
and deep and flush 4 cases (25 %), respectively (Table 2). muscle fiber function contributions with a reference to
There was no statistical significance among the gender and other perioral muscles at the modiolar region. It is impor-
muscle attachment (p > 0.05). tant to understand that risorius can be found in three types

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150
Table 2  Frequency of risorius muscle attachment layer in 80 hemi-
faces stratified by muscle type
PR TR ZR
Superficial 17 (47.2 %) 20 (72.4 %) 8 (50 %)
Flush 13 (36.1 %) 8 (28.6 %) 4 (25 %)
Deep 6 (16.7 %) 0 (0 %) 4 (25 %)
Sum 36 28 16
PR platysma risorius, TR triangularis risorius, ZR zygomaticus riso-
rius
depending on the insertion patterns (ZR, PR, and TR), and
that it has three modalities in inserting at the modiolus in
reference to the DAO. This can provide the crucial informa-
tion in understanding the various facial expressions based
on the muscle anatomy of Asians.
The frequency of three patterns of muscular structures
of risorius was observed differently depending on races.
Although Lightoller [11] mentioned that TR is the most
common type in European, Lefrou and Loth [10, 12] has
described that PR seem to be more frequent in Melanesians
and in Africans. From our results, PR inserting along the
level of the intercheilion horizontal line was the most com-
mon (36 cases, 45 %) and ZR inserting above this line was
the least (16 cases, 20 %). Based on these results, the racial
differences in risorius patterns should be considered prior
to performing the facial aesthetic treatment or surgery.
The results of the present study were performed based
on our previous study in Korean [9]. In this study, we clas-
sified the Korean risorius as five patterns according to the
presence and the course of the risorius muscle fibers. And
the course of the risorius muscle inserting into the modio-
lus were categorized into three types depending on the vec-
tor at major risorius muscle fiber insertion. In the present
study, we tried to demonstrate the layered structure of the
risorius inserting into the modiolar region to provide the
more detailed description of the morphology and insertion
pattern of risorius muscle.
In terms of layering of perioral muscles, this study pre-
sents that superficial attachment of the risorius muscle to
DAO is most frequently observed regardless of the type
(45 cases, 56.3 %). This also disputed commonly acknowl-
edged belief that risorius muscle is always deep to DAO
[6]. Next frequent layer of PR and TR after superficial were
flush plane, whereas, for ZR, it was same frequent deep and
flush plane.
Among all risorius types attaching at superficial level
(45 cases), TR was most frequently found (20 cases,
44.4 %), then PR (17 cases, 37.8 %). Out of all risorius
muscle types attaching flush and deep to DAO (10 cases),
PR was most commonly found in 13 cases (52.0 %) and
6 cases (60 %), respectively (Table 2). When designing
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Surg Radiol Anat (2015) 37:147–151
local flaps for various purposes of facial reconstruction
such as buccinators myomucosal island flap [17] and plat-
ysma muscle cutaneous flap [13], it is essential to recog-
nize the type of risorius and its layer such that they could
minimize any aforementioned discontent outcomes. The
present study will provide guidelines as to estimate which
muscle type and layer is common and also according to
gender allowing better prediction of anatomy of the risorius
muscle.
As face is the most obvious bodily aspect in human
interactions, having deformities or injuries can lead to not
only functional discomfort, but also psychological and
emotional difficulties to the patients. After the facial nerve
(C7) paresis, hypofunctional asymmetry may result and
can require botulinum Neurotoxin (BoNT) injection of the
same muscle groups but on the normofunctional side [2].
Analyzing the expressions of the normofunctional side may
provide guide as to where to inject BoNT such that it may
include the risorius muscle. The results of the present study
thus may also provide valuable information in planning
such injection sites.
Function of risorius is also a critical field of discussion.
Even though common anatomy textbooks acknowledge it
as the ‘grinning’ or ‘smiling’ muscle [5], different types
of risorius may permit different functions. As ZR has an
attachment vector that is from above the intercheilion line,
Hu et al. and Shim et al. [8, 16] reported the bifid zygo-
maticus major muscle was observed that it was difficult
to distinguish between the risorius fibers and the inferior
muscle fibers of the bifid zygomaticus major muscle in the
modiolar region. ZR may serve as part of the lip elevators
as well as retracting the labial commissures. PR, however,
may not have any elevating effects on the lips, and TR may
even help depress the corners of the lips downwards form-
ing an expression of terror or extreme sadness as noted in
Rubin’s study of anatomical expressions of perioral mus-
culature [15]. In Cacou’s study of using EMG to access
the reflex responses of lip muscles, risorius appeared to be
most active when the lips were actively stretched bilater-
ally [1]. Although the present study is a static rather than
a dynamic analysis of the risorius, this observation may be
applicable to facial reanimation surgery. Thus, the func-
tional anatomy of risorius must be greatly emphasized to
restore its natural function.
In conclusion, the risorius muscle type contributions and
insertion variability to each fiber will allow precise predic-
tion of the functionality as a whole and be able to produce
the most favorable outcome.
Therefore, the clinicians will be better prepared when
planning or performing surgical procedures such as facial
reanimation, reconstruction, and cosmetic surgeries around
the perioral muscles. Facial muscle paralysis and trauma
patients will benefit significantly from better surgical
Surg Radiol Anat (2015) 37:147–151 151
outcomes due to the surgeon’s greater knowledge of this
risorius muscle.
Acknowledgments  We are grateful to the donors of the cadav-
ers and bereaved families. This study was supported by the National
Research Foundation of Korea (NRF) grant funded by the Korea Gov-
ernment (MEST) (No. 2011-0007612). The authors have no conflict
of interest to declare in this paper. We thank Sang-hoon Kwon at
New York University College of Arts and Science and So-yeon Kim
at Madeira School, Virginia for assisting in revising manuscript and
anatomical procedure.
Conflict of interest  All authors have no financial and private rela-
tionships with commercial and political organization or people that
could improperly influence this research.
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