Botulinum neurotoxin bont injection for the correction of masseter muscle hypertrophy is an offlabel but. Sep 26, 2011 masseter muscle hypertrophy is a benign condition that can cause facial asymmetry and aesthetic concern in young individuals. Medial pterygoid muscle an overview sciencedirect topics. Masticatory muscle hypertrophy, also known as and commonly presenting as temporalis and masseter muscles hypertrophy, is a rare condition that affects the muscles of mastication and results in pseudomasses. Hypertrophy refers to an enlargement caused by an increase in the size but not in the number of cells. Masseter and medial pterygoid muscle hypertrophy bmj. Even if the hypertrophy is bilateral, asymmetry of the face may still occur due to unequal. Masseteric hypertrophy may present as either unilateral or bilateral painless swelling of unknown origin in the region of angle of mandible. Masseteric hypertrophy associated with administration of. Benign masseteric hypertrophy is an uncommon condition, but one that should be straightforward to diagnose if the entity is born in mind.
Three recent cases presented briefly serve to illustrate this condition. Science and development of muscle hypertrophy 2nd edition pdf free download. Duroux, 2 in 1905, described a 22yearold man with asymptomatic, bilateral hypertrophy of the masseter muscles of six weeks duration. In particular, we will discuss about the role of botulinum toxin in the nonsurgical treatment of masseter hypertrophy, and the use of botulinum toxin type a as an adjunctive therapy of bruxism. Nevertheless, with the inability to activate the masseter muscle for several months after the bta injection, the parafunctional habits that initially caused the muscle hypertrophy often stop and permanent relief can occur. Masseter muscle hypertrophy is a rare condition of unknown cause which is important in the differential diagnosis of head and neck masses, located in the cheek. Masticatory muscle hypertrophy radiology reference. The swelling may on occasion be associated with facial pain and can be prominent enough to be considered cosmetically disfiguring. Generalised masticatory muscle hypertrophy may affect the temporalis muscle, masseters and medial pterygoids in a variety of combinations. The treatment of masseter hypertrophy with botulinum toxin. Pdf aims and objectives the aim of this case series is to retrospectively analyze cases of masseter muscle hypertrophy and the surgical procedures. Benign masseter muscle hypertrophy brazilian journal of. Pdf behavior analysis of electromyographic activity of the. Masseter hypertrophy mh is one of the uncommon conditions that swelling can be.
Nov 01, 2001 the differential diagnosis at this point included masseteric hypertrophy, benign tumor of muscle, or hemangiomalymphangioma. Type a botulinum toxin for the treatment of hypertrophy of. Masseter muscle hypertrophy is a rare condition of idiopathic cause. Benign masseter muscle hypertrophy is an uncommon clinical phenomenon of uncertain aetiology which is characterised by a soft swelling near the angle of the mandible.
Botulinum toxin for masseter reduction in asian patients. Masseter muscle hypertrophy is characterized by unilateral or bilateral enlargement of the masseter muscles affecting both males and females after. Botulinum toxin type a application is most commonly used for the treatment because of its less invasive feature. Complications of botulinum toxin injection for masseter. A prospective study of the effect of botulinum toxin a on masseteric. Nov 01, 2019 masseter muscle hypertrophy is a relatively rare and benign enlargement of unilateral or bilateral masseter muscles. Benign masseteric hypertrophy is a relatively uncommon condition that can occur. Effects of a botulinum toxin type a injection on the masseter. Being one of the main principle muscles of chewing mastication, the masseter muscle is vital to adequate mastication. Associated with the enlargement of the masseter muscle there is usually bony overgrowth at the angle of the mandible, producing a. Combination of medical and surgical treatments for. Hypertrophy may affect any of the masticatory muscles in any combination. Excision of the internal layer of the masseter muscle and reduction of the thickened bone in the region of the mandibular angle, via an intraoral approach.
Idiopathic hypertrophy of the masseter muscle is a rare disorder of unknown. Masseteric hypertrophy and its surgical correction. Pdf botulinum toxin for masseter hypertrophy esther. The additional examinations confirmed the isolated muscle hypertrophy. Benign masseteric hypertrophy is a relatively uncommon condition that can occur unilaterally or bilaterally. Management of masseter muscle hypertrophy and role of. Botulinum toxin type a in the management of masseter muscle hypertrophy. Masseter muscle hypertrophy mmh is most probably a congenital, genetically determined anomaly. The ultrasound scans from these measuring sites constitute a full representation of crosssection of superficial portion of the masseter muscle. Masseter muscle hypertrophy jama dermatology jama network. This hypertrophy is a benign, unilateral or bilateral, painless enlargement of the masseter muscle mm. We next evaluated cardiac and masseter muscle hypertrophy in terms of. Treatment of masseteric hypertrophy with botulinum toxin. Left oblique view with the jaw at rest, showing the extent of the swelling over the left angle of the jaw.
Botulinum toxin for masseter hypertrophy fedorowicz, z. Pdf effect of treatment of dentofacial deformity on. The masseter is the most targeted muscle when treating hypertrophy to produce a smooth face shape. Hypertrophy of masseteric muscle 349 discussion masseter muscle hypertrophy is an asymptomatic, benign enlargement of one or both masseter muscles. Its use for masseter muscle hypertrophy works on the similar principle with the subsequent reduction in the bulk of the muscle. Does botulinum toxin injection into masseter muscles affect. Sep 01, 2008 idiopathic hypertrophy of the masseter muscle is a rare disorder of unknown cause. Dhc, deleterious habits for occlusion and mastication control. It is a relatively rare condition, with around cases reported in the literature since the first described. The masseter muscle originates on the zygomatic arch and the zygomatic process of the maxilla and is inserted into the lateral aspect of the angle and ramus of the mandible. Atlas of botulinum toxin therapy for masseter muscle. The aim of this case series is to retrospectively analyze cases of masseter muscle hypertrophy and the surgical. Nilesh k, dharamsi r, patil p, mate p bmj case rep 2021 jan 18.
Masticatory muscle hypertrophy radiology reference article. Application of botulinum toxin in maxillofacial field. Hypertrophy of the masseter muscle jama otolaryngologyhead. A link to download a pdf version of the trial profile will be included in your email receipt. The measurements of right and left masseter muscle hypertrophy were recorded in centimeter in both relaxed and contracted positions of the masseter muscle figures 7 and 8. The aetiology of masseter muscle hypertrophy has been attributed aetiology and prevalence to a number of factors including. With the changing trends, more and more patients are opting for nonsurgical or minimally invasive options for reshaping the face. Andreadis d, stylianou f, linktsatsouli i, markopoulos a. The masseter muscle can become enlarged in patients who habitually clench or grind with bruxism their teeth and even in those who constantly chew gum. Pdf idiopathic hypertrophy of the masseter muscle is a rare disorder of. He also referred to a 20yearold woman with the same condition who had been observed by champneys.
This asymptomatic persistent muscle enlargement may be initiated by bruxism, clenching, or heavy gum chewing 3,6. Pdf botulinum toxin type a in the management of masseter. Pdf management of masseter muscle hypertrophy and role of. Local therapy with type a botulinum toxin permits an alternative method of treatment.
This masseteric hypertrophy is asymptomatic and soft. Physical examination through intra and extraoral palpation of an inflammation free muscle serve to support the diagnosis. This paper reports a case of unilateral masseter hypertrophy with keloid scar in the angle of the mandible for which surgical treatment. Lower facial remodeling with botulinum toxin type a for the s. However, idiopathic and congenital hypertrophy of the masseter muscle is a rare disorder of unknown etiology. Anterior view with the jaw at rest, showing the facial asymmetry due to bilateral masseter muscle hypertrophy. Pdf benign masseter muscle hypertrophy researchgate. Pain may be a symptom, but most frequently a clinician is consulted for cosmetic reasons. Pdf botulinum toxin for masseter hypertrophy esther van. Although it is tempting to point to malocclusion, bruxism, clenching, or temporomandibular joint disorders, the etiology in. Igf and myostatin pathways are respectively induced during. Treatment protocols include surgical excision or a noninvasive option, using botulinum toxin type a btxa. The temporalis and masseter muscles can be observed for hypertrophy and atrophy, and should be palpated for muscle texture, tenderness, and myofascial trigger points mtrpts.
A computed tomography scan was performed and showed an asymmetry of the left masseter fig 2. Masseter and medial pterygoid muscle hypertrophy bmj case. Physical examination revealed a bilateral hypertrophy of the masticatory muscles, predominantly affecting the right temporalis and the left masseter. Under general anaesthesia, on the right side of the patient, an intraoral in. The medial and lateral pterygoid muscles are difficult to palpate, and therefore, assessment is carried out using intraoral palpation see fig. There appears to be little awareness among pediatricians of masseter or temporalis muscle hypertrophy which may mimic other conditions, particularly parotitis. Masseter muscle hypertrophy occurs as a soft enlargement of the jaw muscles near the angle of the lower jaw and seldom presents a major health problem. The main objectives taken into account are the adjunctive procedures such as genioplasty and coronoidectomy, which help improve the esthetics and mouth. Botox treatment of masseter muscle hypertrophy status. Idiopathic hypertrophy of the masseter muscle is a rare disorder of unknown cause. Bilateral masseter and internal pterygoid muscle hypertrophy.
Masseter muscle hypertrophy mmh is an abnormal enlargement of the masseter muscle, either unilaterally or bilaterally characterized by an increase in the volume of the muscle mass. It sometimes gives a threatening appearance to the face that can create morphopsychological conflict. Major bruxism was assessed by premature dental wearing. In 1930, boldt 3 presented a thesis on masseter hypertrophy. However, in some individuals the swelling can be associated with pain or may be so large that it causes facial disfigurement. Benign hypertrophy of the masseter muscles and mandibular. Benign asymmetric hypertrophy of the masticatory muscles promoted by bruxism was. Some authors associate it with the habit of chewing gum. Variable presentation of temporalis hypertrophy a case report. Masseteric hypertrophy occurs frequently among asians, including koreans, because of racial characteristics and dietary habits. Unilateral masticatory muscle hypertrophy with mandibular. Combination of medical and surgical treatments for masseter.
Management of unilateral idiopathic masseter muscle hypertrophy with botulinum toxin type a. Toxins free fulltext anatomical considerations when treating. Masseter hypertrophy is a benign condition with variable causative factors, such as bruxism, temporomandibular disorders, malocclusion and others, but has an unclear etiology in the majority of cases. A case of painful, initially bilateral, and then unilateral. Treatment of unilateral masseteric hypertrophy with.
The aim of this case series is to retrospectively analyze cases of masseter muscle hypertrophy and the surgical procedures carried out for their treatment in sdm craniofacial unit, dharwad. Bonta treatment for masseteric hypertrophy has not been. Toxin masseter injections have a high efficacy and safety profile, but the risks of a variety of side effects or complications remain. The masseter muscle is essential for adequate mastication and is located laterally to the mandibular ramus, and thus plays an important role in facial. The anatomical basis of paradoxical masseteric bulging. The etiology of mh includes several factors, and various treatment methods are mentioned in the literature. Reduction of the masseter muscle, osteotomy, botulinum toxin, and splint.
The treatment of hypertrophy of the masseter and temporal muscles has to date been dominated by conservative and surgical measures. Science and development of muscle hypertrophy, second edition, is the most comprehensive resource on muscle hypertrophy in the world. Masseter muscle hypertrophy is defined by a soft fullness, near the angle of the mandible. Vita gm, olckers a, jedlicka ae, george al, heimanpatterson t, rosenberg h, fletcher je, levitt rc. In human anatomy, the masseter is one of the muscles of mastication. A severe enough form of masseter hypertrophy may be cosmetically disfiguring. Some authors associate it with the habit of chewing gum, temporomandibular joint disorder, congenital and functional hypertrophies, and emotional disorders stress and nervousness. When the muscle is activated by a clenching of the teeth, its belly can be seen bulging under the skin, and the anterior edge may easily be palpated in the substance of the. Management of unilateral masseter hypertrophy and hypertrophic. Thus we should refer to it as hyperplasia rather than hypertrophy of the masseteric muscle.
Idiopathic masseter muscle hypertrophy semantic scholar. Masseter muscle hypertrophy is a relatively uncommon condition that can occur unilaterally or bilaterally. The use of this toxin was first described in 1994, and since then several studies on this technique have. Masseter hypertrophy has been clinically treated because of esthetic complaints.
Masseter muscle rigidity associated with glycine sup 6 toalanine mutation in the adult muscle sodium channel alphasubunit gene. While the application of botulinum toxin on the masseter muscle is an off. The aim of this study was to investigate the effect of a botulinum toxin type a btxa injection in the masseter muscle using electromyography emg in an animal model. Masseter hypertrophy mh is one of the uncommon conditions that swelling can be seen in the angular mandibular region of the face. The aim of this case series is to retrospectively analyze cases of masseter muscle hypertrophy and the surgical procedures carried out for their.
The treatment of masseter hypertrophy with botulinum toxin type a. Ultrasonographic evaluation of oral submucous fibrosis and. The swelling may on occasion be associated with facial pain and can be prominent enough to. Idiopathic masseter muscle hypertrophy immh was first described by legg in 1880, reporting on the case of a 10yearold girl with concurrent idiopathic temporalis muscle hypertrophy14,7.
Botox treatment of masseter muscle hypertrophy adisinsight. Btx is a neurotoxin protein derived from the bacterium clostridium botulinum and seven. Treatment of unilateral masseteric hypertrophy with botulinum. Several treatment options reported for masseter hypertrophy, which range from simple pharmacotherapy to more invasive surgical reduction.
It is most commonly seen in late adolescence and early adulthood. Masseter hypertrophy is a common, prominent feature in many asian patients, and correction procedures are often requested for esthetic reasons. Masseter and medial pterygoid muscle hypertrophy request pdf. The first published description of masseter hypertrophy was documented in 1880. Masseter muscle hypertrophy is characterized by unilateral or bilateral enlargement of the masseter muscles affecting both females and. Btx a is injected into masticatory muscles masseter and temporalis to treat trismus, bruxism, masticatory muscle myalgia, temporomandibular joint disorders or muscle hypertrophy 9 with a ib. Create a free personal account to download free article pdfs. Hypertrophy of the masseter or temporalis muscles or both. Noninvasive treatments such as incobotulinumtoxina xeomin cosmetic. Concurrent occurrence of masseter muscle hypertrophy along with medial pterygoid muscle makes it a rare entity which is difficult to diagnose clinically specially in the absence of oral manifestations. May 01, 2004 since the 1880s, medical options such as sedatives, muscle relaxants, and occlusal splints have been used to treat benign masseteric hypertrophy.
Commonly seen in anxious individuals with bruxism and in chronic gum chewing 1. The use of bta in mmh therapy offers some obvious advantages in relation to conventional surgical treatment. Pdf masseter muscle hypertrophy is defined as the unilateral or bilateral expansion of the masseter muscle, and little is known about its etiology find, read and cite all the research you. Science and development of muscle hypertrophy 2nd edition pdf. Pdf asymmetric hypertrophy of the masticatory muscles. Radiofrequency volumetric reduction for masseteric hypertrophy. Prospective evaluation of incobotulinumtoxina in the. An animal model study siyeok park1, youngwook park2, youngjun ji3, sungwook park4 and seonggon kim5,6 abstract background. Does botulinum toxin injection into masseter muscles. In some cases prominent exostoses at the angle of the mandible are noted. Jun 21, 2017 masseter muscle hypertrophy is an abnormal hypertrophy that occurs either unilaterally or bilaterally. Masseteric hypertrophy is a relatively uncommon condition which can occur unilaterally or bilaterally, and the etiology is unclear in the majority of patients. Botox onabotulinumtoxina for injection, for intramuscular.
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