Mini Review - Imaging in Medicine (2023) Volume 15, Issue 3

Combination of medical and surgical treatment for hypertrophy of the bite muscle

Ayhan Mohar*

Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Istanbul, Turkey



*Corresponding Author:
Ayhan Mohar
Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Istanbul, Turkey



Received: 1-May-2023, Manuscript No. FMIM-23-92101; Editor assigned: 3-May-2023, Pre QC No. FMIM-23-92101(PQ); Reviewed: 17-May-2023, QC No. FMIM-23-92101; Revised: 22-May-2023, Manuscript No. FMIM-23-92101(R); Published: 30-May-2023; DOI: 10.37532/1755- 5191.2023.15(3).52-53


Masseter Hypertrophy (MH) is one of the exceptional conditions that swelling can be seen within the precise mandibular locale of confront. The etiology of MH incorporates a few components, and different treatment methods are said within the writing. Botulinum poison sort A application is most commonly utilized for the treatment since of its less obtrusive include. As a surgical strategy, a few treatment options that point to reduce muscle mass or reshape the bone tissue within the precise locale are considered. In this case report, a 21-year-old male quiet with one-sided masseter hypertrophy on the correct side is displayed. After the persistent was analyzed with MH, Botulinum poison treatment in two sessions at one-month interims was done. Since the decrease in muscle volume was not in palatable measurements after the Botulinum poison application, the masseter was decreased on the correct side through an intraoral approach. At the same time, bone developments on each side of the angulus mandibula were reshaped and smoothened through an extraoral retro mandibular approach. Clinical and radiographic assessment of the quiet uncovered more stylish and symmetrical appearance within the standard controls. Masseter Hypertrophy (MH) is an exceptional condition that can cause tasteful and useful issues. Stylish issues comprise of unmistakable masseter muscle within the confront, rectangular confront shape, and wide mandibular point. Patients may endure mental issues due to an ugly see.


Medical • Surgical • Hypertrophy • Bite muscle


Differential determination requires clinical history and physical examination and may indeed incorporate complementary creative ability assets such as Attractive Reverberation (MR) and Computed Tomography (CT) looks to avoid other disarranges. Differential determination must comprise of muscle tumors, salivary organ clutters, and inborn masseter myopathy. In some cases, patients may report signs and side effects of well-localized torment. Be that as it may, it is asymptomatic, and patients’ chief complaint is approximately aesthetics. Besides, masseteric musculature is embedded within the mandibular point anatomically and can cause overdevelopment of these points because of its footing strengths. The etiology of MH has been credited to many factors such as pressures and clenching caused by passionate stretch, constant bruxism, masseteric hyperfunction, and parafunction. It is basic to form the differential conclusion of head and neck mass, especially one-sided mass found within the cheek [1, 2].


The conceivable basic pathologic components ought to be surveyed carefully with nitty gritty quiet history and imaging strategies some time recently choosing on treatment. Treatment of MH is disputable. Changing degrees of victory have been detailed for a few of the treatment alternatives for MH which extend from basic pharmacotherapy to more obtrusive surgery. Diminishment of the masseter muscle, osteotomy, botulinum poison, and prop treatment are alternatives for overseeing this problem. Infusion of botulinum poison sort A into the masseter muscle is considered as a less obtrusive methodology and has been detailed to be effectively utilized for restorative chiseling of the lower confront. Botulinum poison sort A (botulinum poison) may be a powerful neurotoxin which is delivered by the anaerobic living being Clostridium botulinum and when infused into a muscle causes obstructions with the neurotransmitter component, creating specific loss of motion and consequent decay of the muscle. Comes about appeared the proficiency of botulinum in MH, but numerous times in MH concomitant with bone extension within the angulus; subsequently, the leading tasteful comes about may be picked up with control of the hard structure [3, 4].

The conventional strategy of treatment for MH is the halfway surgical extraction of the masseter muscle and osteotomy of the mandibular point locale and reshaping the ebb and flow of the bone beneath common anesthesia. The utilize of an intraoral approach was to begin with proposed by Wood. He suggested the evacuation of bone broadening of the mandibular point without any masseter muscle control. They have supported an intraoral approach including masseter muscle reduction and mostly monocortical and bicortical osteotomy within the mandibular point within the treatment of MH [5, 6].


A 22-year-old male understanding connected to our clinic for effortless topsy-turvy swelling on the correct side of the confront for five years. The history of the quiet uncovered that there are no para functional propensities, useful and mouth opening restriction, bruxism, and injury. Additionally, the masseteric locale was non tender and typical in tone, and the temporo mandibular joints and mandibular angulus locale were not agonizing on palpation. The patient said that the as it were complaint was stylish and he needed to have a more alluring facial appearance. Computed tomography, MR creative ability, and all encompassing radiographs were taken to form a differential determination of MH. In MR examination, critical extension of the proper masseter muscle compared to the cleared out side was actually perceptible. There was moreover no neurotic arrangement within the muscle [7, 8].


In CT and panoramic radiographs, receptive bone arrangement and noteworthy asymmetry compared to the cleared out side were watched within the mandibular precise locale on the correct side. The quiet was analyzed with masseter hypertrophy. It was chosen to apply botulinum poison as the primary step of the treatment. Botulinum poison sort A (Botox; Allergan Inc., Irvine, CA) was provided as a freeze-dried powder of 100 units and was reconstituted with 2 ml of sterile saline arrangement, giving a concentration of 100 units. Percutaneous intramuscular infusion of botulinum poison sort A was performed to the hypertrophic muscle using 2 ml syringe with 25g needle. 75 units of botulinum poison sort A was infused similarly into five focuses at the middle of the lower third of the masseter muscle. Deciding the number of infusion focuses is based on our clinical encounter and past palatable comes about as infusions are more homogenously found within the masseter muscle. A month afterward, an extra 60 units of botulinum poison were connected to the muscle at the moment visit. A diminish within the estimate of the masseter muscle was seen after one month of the application. Inside the six months’ follow-up period, extreme masseter muscle decay happened, but in spite of the fact that clinically critical decay has happened, the understanding was not completely fulfilled with his appearance. In this way the choice to perform surgery has made with authorization of the quiet and his family in arrange to diminish the volume of the correct masseter muscle and mellow the couture of the patients confront [9, 10].



Conflict of Interest



  1. Nimmerjahn F, Ravetch JV. Fc-receptors as regulators of immunity. Adv Immunol. 96, 179-204 (2007).
  2. Indexed at, Google Scholar, Crossref

  3. Nimmerjahn F, Ravetch JV. Fcgamma receptors: Old friends and new family members. Immunity. 24, 19-28 (2006).
  4. Indexed at, Google Scholar, Crossref

  5. Brambell FW. The transmission of immunity from mother to young and the catabolism of immunoglobulins. Lancet. 2, 1087-1093 (1966).
  6. Indexed at, Google Scholar, Crossref

  7. Pyzik M, Sand KMK, Hubbard JJ et al. The Neonatal Fc Receptor (FcRn): A Misnomer Front. Immunol. 10, 1540 (2019).
  8. Indexed at, Google Scholar, Crossref

  9. Andersen JT, Daba MB, Berntzen G et al. Cross-species binding analyses of mouse and human neonatal Fc receptor show dramatic differences in immunoglobulin G and albumin binding. J Biol Chem. 285, 4826-4836 (2010).
  10. Indexed at, Google Scholar, Crossref

  11. Bonati M. Early neonatal drug utilisation in preterm newborns in neonatal intensive care units: Italian collaborative group on preterm delivery. Dev Pharmacol Ther. 11, 1-7 (1988).
  12. Indexed at, Google Scholar, Crossref

  13. Eriksson M. Neonatal septicemia. Acta Paediatr. Scand. 72, 1-8 (1983).
  14. Indexed at, Google Scholar, Crossref

  15. Schelonka RL, Infante AJ. Neonatal immunology. Semin Perinatol. 22, 2-14 (1998).
  16. Indexed at, Google Scholar, Crossref

  17. Friis-Hansen B. Body water compartments in children: changes during growth and related changes in body composition. Pediatrics. 28, 169-181 (1961).
  18. Indexed at, Google Scholar

  19. Morselli PL, Franco Morselli R. Clinical pharmacokinetics in newborns and infants. Age-related differences and therapeutic implications. Clin Pharmacokinet. 5, 485-527 (1980).
  20. Indexed at, Google Scholar, Crossref

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