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Background With the changing trends, more and more patients are opting for nonsurgical or minimally invasive options for reshaping the face. Noninvasive treatments such as incobotulinumtoxinA (Xeomin Cosmetic® ; Merz Pharma Canada Ltd., Burlington, ON, Canada) are a preferred modality for reducing the volume of the muscle and therefore reducing the width of masseter. Aims To evaluate the efficacy of Xeomin treatment in long-term management of bilateral masseter hypertrophy in Asian Indian patients. Patients/methods A total of 30 patients were enrolled in the study and were injected with 30 U Xeomin on each side of face, at baseline. Fifteen patients received a second session of Xeomin injection at 12th week, and remaining 15 patients received an additional third session, at 12th and 24th weeks post the first injection, respectively. Follow-up was done at 4th-, 12th-, 24th-, and 36th-week and at first- and second-year follow-ups. Results For the patients who received two injections, the maximum reduction of 26.85% was observed at 24th week, which was maintained as 20.04% reduction until second follow-up year. The patients who received three injections exhibited very high reduction of 43.12% of masseter volume at 36th week, which was maintained at 38.72 % until the second follow-up year. Three sessions of Xeomin injections were proved to be more effective in long-term maintenance of reduced masseter volume than 2 sessions of injections. Conclusions Xeomin injections were found to be effective in long-term management of bilateral masseter hypertrophy. This is the first of its kind paper, which evaluates the long-term effects of Xeomin injections for the treatment of masseter hypertrophy.

Background Asian women usually view the oval face, with a beautiful curve and clear outline, as elegant. The fat and bloated mid-lower face, with an undefined outline, takes away from what they perceive to be a beautiful appearance. Not only a bone but also soft tissue determine the shape of the mid-lower face. In this article, we introduce a modified surgical method of soft tissue for mid-lower facial recontouring, which can improve the fat and undefined outline of the mid-lower face caused by benign masseter muscle hypertrophy and reduce subcutaneous fat accumulation at the same time. The operative technique is simple and effective with few complications. Methods The surgical treatment of 36 patients who met the adaptation criteria was carried out by laser-assisted liposuction combined with masseter muscle dissection. All patients were followed up postoperatively, and the surgical efficacy was evaluated on the basis of: the comparison of facial contours of patients before and after surgery, the change of masseter muscle thickness detected by B-ultrasound imaging, the satisfaction of patients with postoperative facial contour improvement, and the incidence of complications. Results Between March 1, 2018, and August 31, 2019, 36 patients with indications underwent this procedure. The follow-up lasted 6 to 12 months postoperatively and demonstrated that all patients were satisfied with the postoperative results, of which 33 cases (91.7%) were very satisfied, and 3 cases (8.3%) were satisfied with the treatment and had obvious improvement of the appearance of their mid-lower face. Preoperatively, the average mandibular bigonial breadth was 138.6±8.3 mm, and the average thickness of the masseter muscle was 13.9±0.8 mm; the postoperative breadth was 123.3±7.7 mm, and the thickness was 10.1±0.2 mm. The average reduction of the lower face width and masseter thickness were 15.2±2.1 mm and 3.8±0.1 mm, respectively. No complications occurred among the 36 patients. Conclusion The described method makes a great improvement in reshaping the outline of the mid-lower face, improves the fat and unclear outline of the mid-lower face caused by masseter muscle hypertrophy, and reduces subcutaneous fat accumulation. The procedure is easy to perform and is minimally traumatic, allowing for a quick recovery with few complications. These advantages along with the patients’ overall satisfaction with the results make it worthy of clinical application.

Background: Ultrasonography (USG) has emerged as a real time imaging modality capable of assessing the thickness and depth of the affected oral mucosa in a potentially malignant condition like Oral Submucous Fibrosis. Aim: To test the efficiency of Ultrasonography as a diagnostic tool in Oral Submucous Fibrosis and correlate it with clinical staging. Settings and Design: Analytical Cross-sectional study conducted in Department of Oral Medicine, Diagnosis and Radiology (OMDR) for patients with a history of areca nut chewing, with and without Oral Submucous Fibrosis with USG for assessing Masseter thickness on right and left side. Materials and Methods: USG was done to assess Masseter muscle thickness on the right and left side for 90 patients, 45 with a history of habit and Oral Submucous Fibrosis and 45 with history of habit and without Oral Submucous Fibrosis. Statistical Analysis: Using SPSS Software, Intra, and Intergroup comparison of frequencies of clinical variables and thickness of masseter muscle on USG was done using the Chiquare test. Result: In group 1, intergroup comparisons showed a concomitant increase in Masseter thickness with an increase in severity of Oral Submucous Fibrosis on USG, which was statistically significant. In group 2, USG could detect the increased thickness of the masseter despite the absence of clinical signs and symptoms. Conclusion: Ultrasonography was effective in determining the thickness of the Masseter in subjects with Oral Submucous Fibrosis. Initial thickening of the muscle in patients with no Oral Submucous Fibrosis was noted, thus proving the diagnostic value of USG in Oral Submucous Fibrosis.

Masseter muscle hypertrophy is defined as the unilateral or bilateral expansion of the masseter muscle, and little is known about its etiology. Here we report a case of masseter muscle hypertrophy in a female patient in her 20 s who complained of facial asymmetry. Because of the hemifacial overgrowth of the right-side maxillofacial region from birth, she was thought to have congenital hemifacial hyperplasia. After orthodontic treatment and osteotomy, the patient underwent debulking of the right masseter muscle. Histologically, the surgical specimens exhibited thick masseter muscle fibers arranged irregularly. Masseter muscle cells exhibited diameters in the range of 20–60 μm.

Masseter muscle hypertrophy manifests itself as enlargement of the masseter muscle. It can be associated with a square-angled lower face, pain, dental attrition, maxillary and mandibular bone resorption, and accelerated aging process of the lower face. The objective of this study was to assess the efficacy and safety of botulinum toxin type A in contouring the masseter and its impact on quality of life and the aging process of the lower face, and its role in full face rejuvenation.A PubMed search was conducted for articles on masseter treatment with botulinum toxin type A, masseter muscle hypertrophy, and the aging process of the lower face. Key studies are reviewed and findings are summarized.Botulinum toxin type A can be injected into the lower posterior aspect of the masseter muscle. Treatment decreases muscle bulk and reshapes the lower face. Furthermore, patient quality-of-life measures, including pain and symptoms of grinding and clenching, are improved. Treatment can decrease shear stress on maxillary and mandibular bones and can possibly prevent tooth loss and progressive bone resorption of the lower face. Adverse effects are minimal and short lasting.Botulinum toxin type A is a safe and effective treatment of masseter hypertrophy. The treatment results in improvement of functionality and cosmesis, and restoration of facial harmony.

Botulinum toxin type A (BoNTA) is a powerful neurotoxin that inhibits acetylcholine release from presynaptic vesicles. The potency and safety profile of BoNTA grant the toxin vast therapeutic potential. It has been used off-label for a variety of dermatologic conditions. This review aims to analyze published literature regarding the benefits and risks of the off-label use of BoNTA beyond facial lines, including eccrine hidrocystomas, enlarged pores, keloids and hypertrophic scars, hidradenitis suppurativa, hyperhidrosis, masseter muscle hypertrophy, and salivary gland hypertrophy, among others. A MEDLINE search from January 2000 to December 2019 was conducted on the off-label uses of botulinum toxin in dermatology.

Masseter hypertrophy is a characteristic condition resulting from an increase in the size of the muscle mass. At times, it produces significant facial asymmetry and is an important finding in the differential diagnosis of similar located entities. A proper diagnosis of this condition would avoid more aggressive and unwarranted therapy by an inexperienced clinician who may mistake it for a more serious pathologic condition. This article reports two cases of bilateral masseter hypertrophy having characteristic diagnostic features, along with specialized imaging modalities and review of literature.

Masseter Muscle Hypertrophy (MMH) is a well-known clinical benign condition that is not gender-specific and it can be monolateral or bilateral. Botulinum Toxin type A (BoNTA) injection has been widely described for MMH treatment and non-surgical facial slimming. BoNTA masseter injections have high efficacy and safety profile, but the risks of side effects remain. Muscular bulging during mastication is a complication due to the superficial overcompensation of masseteric fibers in response to neurotoxic weakening of the deep masseter. We present a biphasic-injection technique for BoNTA administration, based following anatomical concept and developed in order to prevent paradoxical bulging. A total of 98 treatments from 2015 to 2020 were performed with this technique. No remarkable complications occurred in our study. No cases of loss of full smile, difficulty in mouth opening, dizziness, headache, neurapraxia, and xerostomia were reported. A case of asymmetric smiling was self-resolved within a week. No patient claimed transient muscle weakness as distressing. No cases of paradoxical bulging were observed. Extensive knowledge of muscular anatomy and appropriate injection technique are key factors in achieving the desired result and avoiding complications. We feel that sharing this tip could be helpful for all the physicians involved in MMH treatment with BoNTA.

Bilateral masseter muscle hypertrophy is an alteration in shape and thickness of the masseter muscles that can modify the width of the lower face causing aesthetic and functional problems. A 21-year-old man was referred to the Department of Maxillofacial Surgery at the Civil Hospital in Brescia by his dentist for an evaluation of his facial appearance with a square-face type. To reduce the undesirable facial appearance, a surgical intraoral approach was performed; the procedure includes the bilateral dissection of the masseter muscle, partial lipectomy, and the ostectomy of the mandibular angle assisted by a surgical guide built on a stereolithographic model. The patient was satisfied with the functional and aesthetic outcomes of both the profile and the frontal views. There was no evidence of complication at a 1-year follow-up. This new method yields optimal aesthetic results with an enhanced outline of the lower face.

A hipertrofia idiopatica do masseter e uma patologia rara, caracterizada por aumento uni ou bilateral deste musculo, por vezes associada a exostose do ângulo mandibular.() A etiologia e desconhecida, com possivel relacao com esforcos mastigatorios unilaterais, ma oclusao dentaria, disfuncao da articulacao temporomandibular, bruxismo ou perturbacoes emocionais.(,) O diagnostico e fundamentalmente clinico, complementado com ecografia e eventual recurso a ressonância magnetica.() E importante o diagnostico diferencial com tumores ou processos inflamatorios musculares, osseos e das glândulas salivares.() Apresenta-se o caso [...]

Masseter hypertrophy (MH) is an uncommon disorder which can cause both aesthetic and functional problems. The most common aetiological factors associated with MH are habit of chewing gum, clenching and/or bruxism. The treatment of MH includes conservative management as well as surgical resection of the enlarged muscle and/or bone. Injection of botulinum toxin type A is a relatively new and minimally invasive method for management of masseter muscle hypertrophy, which offers many advantages over conventional surgical management. This paper reports a case of unilateral MH of unknown origin which was treated with injection of botulinum toxin type A, resulting in satisfactory reduction in the volume of muscle and improvement of facial aesthetics.

Idiopathic hypertrophy of the masseter muscle is a rare disorder of unknown cause. Most patients complain of the cosmetic change caused by facial asymmetry, also called as Square face, however symptoms such as trismus, protrusion,bruxism may also occur. The goals of the present article are to- report 2 cases of idiopathic masseter hypertrophy within a same family, describe its symptoms and treatment. The main presenting complaints were bilateral bulging in the region of angle of mandible, of slow and progressive evolution and managed conservatively as oppose to the routine surgical treatment used so far.

Aims and Objectives: 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. The main objectives taken into account are the adjunctive procedures such as genioplasty and coronoidectomy, which help improve the esthetics and mouth opening of the patients postoperatively. Materials and Methods: This retrospective case series was conducted in the Department of Oral and Maxillofacial Surgery, SDM craniofacial unit, Dharwad, from 2010 to 2015. A total of 5 cases were operated on during this period. Orthopantomograms, computed tomography scans of the head and neck region, and lateral cephalograms of each patient were taken into account. Data were collected to study the treatment protocols and the adjunctive procedures, which helped improve the results of the surgery. Results: Of the 5 patients operated in the last 5 years, surgical debulking of the masseter muscle was the optimal treatment followed with genioplasty, which provided improved esthetics from the square-shaped jaw appearance. Coronoidectomy was helpful in increasing mouth opening in patients with trismus. Conclusion: The case series was not only carried out to enunciate causes of masseter muscle hypertrophy and its complications but also to discuss optimal treatment protocols along with adjunctive procedures to enhance the postoperative results and patient satisfaction.

Background: Despite the multitude of clinical and aesthetic uses, the correct surgical indications for buccal fat pad (BFP) removal have yet to be fully elucidated. Although the procedure is widely performed and promoted for aesthetic purpose, literature lacks of studies accounting for a proper evaluation of patients undergoing BFP removal.Methods: Between 2012 and 2016 patients seeking an improvement of the malar contour by reduction of the submalar prominence have been visited at the Department of Plastic Surgery of the Institution. A preoperative MRI was requested in order to correctly identify the volume of the BFP and the presence of a masseter muscle (MM) hypertrophy.Results: According to clinical examination and the results of the preoperative imaging, patients were offered different treatment options: patients with BFP hypertrophy underwent BFP removal through an itraoral approach; patients with MM hypertrophy received injection of 50 UI of botulinum toxin (BTX). No complications were observed in the postoperative period and all patients were satisfied with the results.Conclusions: According to the experience, midface contouring procedures should take account of both surgeons’ experience, patients’ expectations and anatomical evaluation. As such, there is no given approach suitable for all cases. Suggested visual criteria, clinical examination and imaging analysis are useful in establishing patient’s condition and determining the appropriate methods of treatment to enhance the facial profile.

Sleep bruxism is a temporomandibular joint dysfunction that could conclude in various problems including masseter muscle hypertrophy, headaches, and periodontal problems. Despite various treatment strategies, such as behavioral therapy, oral appliances, and pharmacotherapy, suggested, there is no specific treatment for this disorder. We present a 7-year-old boy whose sleep bruxism symptoms disappeared with a single daily dose of buspirone treatment in this report.

Facial asymmetry can either be physiological or pathological and is a common cosmetic concern. A 35-year-old Indian male presented with broad appearing lower face and prominent left jaw since adolescence. Parotid enlargement and other local disorders were ruled out. Ultrasonographic thickness of right masseter muscle was 13 mm while that of left was 14.9 mm, in unclenched state. Type-A botulinum toxin (T-ABT) was injected, evenly at five points, in both muscles within the “safe zone”. Using a 29 gauge needle, 15 and 25 international units were delivered to right and left masseters, respectively. Six months post — injection, a reduction of 2.9 mm and 4.4 mm was observed along with a reduced external facial asymmetry. At 24 months, patient maintains a satisfactory facial contour with no significant early or late post-injection complications. Intra-massteric injection of T-ABT can be used effectively as a primary or adjunct procedure for holistic oculo-facial sculpting.

For correction of this asymmetrical hypertrophy, botulinum toxin type A (BTxA) injection is one of convenient treatment modalities. Unfortunately, physical examination of masseter muscle is not enough to estimate the exact volume of muscle hypertrophy difference. Two Koreans, male and female, of bilateral masseter hypertrophy with asymmetricity were evaluated. BTxA (NABOTA(®), Daewoong, Co. Ltd., Seoul, Korea) was injected at master muscle site with total 50 U (25 U at each side) and volume change was evaluated with three-dimensional (3D) CT image analysis. Maximum reduction of masseter hypertrophy was recognized at 2-month follow-up and reduced muscle size started to restore after 3 months. Mean reduction of masseter muscle volume was 36% compared with baseline. More hypertrophied side of masseter muscle presented 42% of volume reduction at 2-month follow-up but less hypertrophied side of masseter muscle showed 30% of volume shrinkage. In conclusion, 3D CT image analysis might be the exact evaluation tool for correction of asymmetrical masseter hypertrophy by botulinum toxin injection.

Masseter muscle hypertrophy is an untypical anomaly with no definite cause and its diagnosis is easily completed through physical examination and imaging examinations. In some cases, patient may report signs and symptoms of well-localizated pain. However, it is generally asymptomatic and patient's chief complaint is about esthetic because of facial asymmetry. In this case, surgery is carefully indicated. The aim of this article is to report a case of a male patient with no painful and functional complaints but an important unease over his facial asymmetry. Patient underwent surgery involving bilateral resection of mandibular angles and unilateral resection of masseter muscle through intraoral approach. Surgical approaches and techniques rely heavily on surgeon. There are few reports in the literature about this anomaly, but those available present several techniques. The surgeon's dexterity and knowledge become extremely important, whereas this procedure is essentiallyesthetic.

Definimos la hipertrofia del músculo masetero como el crecimiento excesivo de la masa muscular de dicho músculo, de presentación subclínica y de etiología multifactorial. Presenta una incidencia entre los 20 a 40 años sin predilección de sexo. Desde que en 1880 Legg la describiera por primera vez, se han intentado múltiples tratamientos, desde los médicos hasta los quirúrgicos, siendo el tratamiento con toxina botulínica el de mayor aceptación en la actualidad. El objetivo del presente artículo es realizar una revisión bibliográfica y proveer una herramienta para el médico que se enfrente a la hipertrofia del músculo masetero, además de presentar un caso clínico unilateral y la técnica empleada para su tratamiento. Como método diagnóstico en el paciente empleamos TAC de cráneo y macizo facial con cortes finos a 1 mm, así como de la región maseterina y aplicamos toxina botulínica de acuerdo a la zona de seguridad propuesta por Nam-Ho Kim y en base a los puntos anatómicos que indica el mismo protocolo, a dosis de 50 U en intervalos de 3 meses. Empleamos también TAC postoperatorio como medio de evaluación del resultado. Los tratamientos médicos con toxina botulínica son variables en sus dosis, aplicaciones y técnicas, así como en los diferentes productos disponibles en el mercado. En nuestro caso, el resultado fue clínicamente satisfactorio, cubriendo en su totalidad las expectativas del paciente. Proponemos que la protocolización del paciente, las dosis adecuadas, el tiempo entre aplicaciones y los sitios anatómicos correctos de inyección, llevan a la corrección de la hipertrofia del músculo masetero.

The masseter muscle has superficial tendons that interdigitate like a saw (tendinous digitations), but a detailed description of these tendons is lacking in anatomic textbooks and atlases. The aim of the present study was to elucidate the topographic anatomy of the masseter muscle, focusing on its tendinous digitation. Sixty-five adult faces (113 sides) were dissected. Five parameters, including the lengths, widths, and thickness of the muscle, were measured. The number and morphology of tendinous digitations were also investigated. The length and width of the masseter muscle were longer and wider in male specimens than in female specimens. The number of masseter muscle tendinous digitations was predominantly two in males and three in females. The length of the tendinous digitations tended to be about three-quarters of that of the muscle. The second tendinous digitation was the longest in male specimens, while the first tendinous digitation was the longest in females. Based on our results, the external morphology of the masseter muscle does not match that described in anatomical atlases and textbooks. These findings may be helpful as a basic reference and in the treatment of masseter muscle hypertrophy and masseter tenomyositis. Clin. Anat. 25:889–892, 2012. © 2012 Wiley Periodicals, Inc.

Masseter muscle hypertrophy is a rare condition of idiopathic cause. It clinically presents as an enlargement of one or both masseter muscles. Most patients complain of facial asymmetry; however, symptoms such as trismus, protrusion, and bruxism may also occur. Several treatment options reported for masseter hypertrophy are present, which range from simple pharmacotherapy to more invasive surgical reduction. Keloid scar with unilateral masseter hypertrophy is a rarely seen in clinical practice. This paper reports a case of unilateral masseter hypertrophy with keloid scar in the angle of the mandible for which surgical treatment was rendered to the patient by using a single approach.

This case reports the findings and the treatment planning of a 16-year-old girl who complained of localized swellings on both sides of the jaws along with pain and restricted mouth opening. Clinical and radiographie examinations revealed bilateral masseter muscle hypertrophy which was associated with severe clenching under stressful conditions. Occlusal splint therapy along with muscle relaxants and infrared therapy was implemented to relieve pain and restricted mouth opening. On subsequent follow-ups, patient reported with significant relief in pain as well as an appreciable increase in mouth opening.

Background Botulinum toxin type A (BTX-A) is widely used for the clinical treatment of masseteric hypertrophy. Until now, few reports have discussed how to prolong the duration of its effectiveness. Objective This study evaluated that purposely adjusting the masticatory movements is possible of postponing the masseter muscle rehypertrophy. Methods Ninety-eight patients were randomly and equally divided into 2 groups, and 35 U BTX-A per side was injected into the masseters. The thickness and volume of the masticatory muscles were measured by ultrasound and computerized tomography, respectively. Patients in Group 1 were instructed to strengthen their masticatory effort during the denervated atrophic stage of the masseter (the interval was evaluated by real-time ultrasound monitoring), whereas patients in Group 2 were not given this instruction. When the masseter muscle began to recover, patients in both groups were instructed to reduce their chewing. Results The duration of the masseter muscle rehypertrophy was significantly prolonged in Group 1 patients. The thickness and the volume of the other masticatory muscles were significantly increased in Group 1 but were either slightly decreased or insignificantly different in Group 2. Conclusion Purposely strengthening masticatory muscle movement during the denervated atrophic stage of the masseter can prolong the duration of masseter rehypertrophy.

Background: Oral submucous fibrosis (OSMF) is a chronic insidious disease of the oral mucosa, commonly seen in South East Asia. It occurs mainly due to the habit of quid or gutkha chewing. There is a clear dose dependent relationship between gutkha chewing and development of OSMF, also due to continuous chewing for larger intervals of time unnecessary forces are exerted on the muscles mainly the masseter muscle. So, the present study was done to evaluate the thickness of masseter muscle in OSMF patients and to compare it with normal patients. Materials and Methods: The present study involved 50 subjects, 25 OSMF patients and 25 normal individuals. The thickness of masseter muscle was evaluated by ultrasonography (5-11mHz). Results: There is a positive association between masseter muscle hypertrophy and OSMF (p-value 0.001). Thickness of masseter muscle was found to be more in OSMF patients as compared to control group and also thickness is more during contraction as compared to relaxation in both OSMF patients and normal individuals.

The one-stage curved osteotomy of the mandibular angle without resection of the masseter was used for 38 patients suffering from prominent mandibular angle from december 1996 to november 1997 at our department of plastic and cranio-maxillo-facial surgery. The preoperative strategy and surgical procedure are described. These 38 cases had a low rate of complications and usually good cosmetic results. Technical refinements that have improved the results are analyzed. At the present time the one-stage curved osteotomy of the mandibular angle is a simple and more reliable method for the surgical correction of the prominent mandibular angle, which is preferred by us to the other techniques: resection of the masseter alone or with straight cutting of the mandibular angle, simple straight cutting of the mandibular angle, multistaged osteotomy of the mandibular angle.

OBJECTIVES In this study, we aimed to evaluate the long-term efficacy of botulinum toxin A injection in reducing the masseter muscle thickness. PATIENTS AND METHODS Between 2007 and June 2008, we retrospectively analyzed the data from 28 patients (21 females, 7 males; mean age: 25.5±4.5 years; range 20 to 46 years) with benign masseter hypertrophy treated with botulinum toxin A injections. All patients were diagnosed by the morphometric analysis of the masseter muscle. The injections were repeated intermittently every six months and totally for six times. The patients were recalled and the last measurement was performed at a mean follow-up of 13.2 months. RESULTS The values obtained following consecutive injections were compared and a statistically significant reduction in thickness of masseter muscle thickness after every single injection was found (p