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Masseter muscle prominence, also known as masseter hypertrophy, refers to the enlargement of the masseter muscle, which is one of the muscles used for chewing. This condition can be caused by various factors, including emotional stress, chronic teeth clenching or grinding, and repetitive habits such as gum chewing. While masseter muscle prominence is typically not dangerous, it can cause psychological distress due to the change in facial appearance, such as a square-angled face. Treatment options range from conservative therapies, such as splint therapy and behaviour therapy, to surgical procedures, and even Botox injections, which have shown significant reductions in masseter muscle volume in clinical trials.
Characteristics and Values of Masseter Muscle Prominence
| Characteristics | Values |
|---|---|
| Definition | Masseter muscle hypertrophy refers to the enlargement of the masseter muscle. |
| Cause | The exact cause is unknown, but emotional stress, chronic clenching/grinding, gum chewing, and other repetitive habits can contribute to overworking the masseter muscles. |
| Symptoms | Masseter hypertrophy is typically asymptomatic but can be associated with pain, clenching/grinding, and functional disorders of the jaw. It can also cause a square-angled face, creating a more masculine look in female faces or a bottom-heavy appearance. |
| Treatment | Conservative/non-surgical therapies include splint therapy, behavior therapy, and botulinum toxin type A (Botox) injection therapy. Surgical procedures include partial removal of the masseter muscle and jawbone or liposuction of the fat near the muscle. |
| Diagnosis | Masseter muscle prominence is diagnosed using the Masseter Muscle Prominence Scale (MMPS) by an investigator or the patient (MMPS-P). |
| Treatment Options | OnabotulinumtoxinA has been shown to significantly reduce masseter muscle volume and MMP severity with an acceptable safety profile. |
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What You'll Learn
Masseter muscle hypertrophy
The masseter muscle is essential for adequate mastication (chewing) and is located laterally to the mandibular ramus. Humans have two masseter muscles, one on each side of the face, which form a part of a group of four pairs of muscles used for chewing. The masseter muscle helps elevate the lower jaw and assists in the forward movement of the lower jaw.
There are several factors that can contribute to overworking the masseter muscles, leading to hypertrophy. These include emotional stress, chronic clenching or grinding during the day or while sleeping, repetitive habits such as gum chewing, or simply a preference for chewing on one side. While the enlarged muscle itself is not dangerous, it is necessary to rule out other potential causes of facial swelling, such as muscle tumours, salivary gland disorders, or other growths in the head and neck region.
Treatment options for masseter muscle hypertrophy include conservative or non-surgical therapies, such as splint therapy, behaviour therapy, and botulinum toxin type A (Botox) injection therapy. Surgical treatments are also available and typically involve the removal of part of the masseter muscle and jawbone or liposuction of the fat near the muscle.
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Causes of masseter hypertrophy
The masseter muscle is one of the major muscles of mastication (chewing). It is a strong, dense muscle located between the cheek and jaw, attaching to the zygomatic arch and mandible. Masseter muscle prominence refers to the enlargement or hypertrophy of this muscle, which can lead to a square-shaped jaw and a more pronounced lower facial appearance. There are several causes of masseter hypertrophy, including:
Dental Parafunctional Habits
Parafunctional habits are activities that go beyond the normal function of an organ or body part. In the case of the masseter muscle, parafunctional habits often involve the teeth and jaw. Bruxism, or teeth grinding and clenching, is a common habit that can lead to masseter hypertrophy. This is because the constant contraction and overuse of the masseter muscle stimulates muscle growth. Bruxism often occurs during sleep, but it can also happen subconsciously during the day. Additionally, excessive chewing of gum or other tough substances can also cause the masseter muscle to enlarge.
Chewing Habits and Diet
Chewing is the primary function of the masseter muscle, and certain dietary and behavioral factors can contribute to its enlargement. A diet that requires extensive chewing, such as one containing tough meats or raw vegetables, can lead to masseter hypertrophy. Additionally, cultural and regional dietary practices can play a role. For example, in some cultures, betel nut or quid chewing is common, and the constant chewing action can stimulate masseter muscle growth over time.
Neurological Conditions
Certain neurological disorders can also lead to masseter hypertrophy. For instance, hemifacial spasm is a condition characterized by involuntary contractions of the facial muscles, including the masseter. The repeated contractions can cause the muscle to enlarge. Similarly, in a condition called Meige syndrome or bruxism dystonia, patients experience both oromandibular dystonia (involuntary jaw movements) and bruxism, which can result in masseter hypertrophy.
Genetic Factors
Genetics also play a role in masseter muscle prominence. Some individuals are genetically predisposed to having larger masseter muscles. This can be a result of inherent muscle fiber composition and distribution, which varies among individuals. In some cases, a strong family history of masseter hypertrophy can be observed, suggesting a genetic component to this condition.
Other Factors
In rare cases, masseter hypertrophy can be a symptom of underlying medical conditions. For example, masseter muscle enlargement can be seen in patients with endocrine disorders, such as acromegaly (excess growth hormone) or hyperthyroidism, due to the stimulating effects of hormones on muscle growth. Additionally, inflammatory conditions, such as masseteric hypertrophy syndrome, can cause unilateral or bilateral enlargement of the masseter muscle.
Understanding the causes of masseter hypertrophy is important for developing appropriate treatment plans, which may include behavioral modifications, dental interventions, or, in some cases, surgical procedures to reduce the muscle prominence.
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Diagnosis of masseter hypertrophy
Masseter muscle hypertrophy is a rare condition with no known cause that has become more prevalent due to growing aesthetic concerns. It is distinguished by either unilateral or bilateral enlargement of the masseter muscles, which can cause cosmetic issues and discomfort for patients. The masseter muscle is the bulkiest and strongest muscle of the face and is responsible for elevating the mandible to bite. Its hypertrophy can lead to functional impairments such as trismus, protrusion, and bruxism.
- Clinical History: A detailed clinical history is essential for diagnosis. Patients may report a gradual increase in swelling in the angle of the mandible over several years. It is important to inquire about any relevant habits, such as teeth clenching, gum chewing, or teeth grinding, as these activities can contribute to overworking the masseter muscles. Emotional stress and psychological disorders can also be contributing factors.
- Physical Examination: The physical examination typically includes a thorough inspection of the face, palpation of the masseter muscle, and assessment of muscle function. During palpation, the patient may be asked to clench their teeth to make the muscle more prominent, allowing for a more precise examination.
- Imaging Techniques: Imaging modalities play a crucial role in the diagnosis of masseter hypertrophy. These include:
- Conventional Radiographs: Orthopantomograms and anteroposterior views of the face can provide valuable information for diagnosis.
- Computed Tomography (CT) Scans: CT scans offer excellent visualization of the masseter muscle and its surrounding structures, aiding in the differential diagnosis process.
- Magnetic Resonance Imaging (MRI): MRI scans are particularly useful due to their ability to detect muscle structural signals, which can help differentiate masseter hypertrophy from other conditions.
- Ultrasound Scanning: Ultrasound can also be employed to assess the masseter muscle and support the diagnosis.
Differential Diagnosis: It is crucial to differentiate masseter hypertrophy from other conditions that can present similar symptoms. These include muscle tumors, salivary gland disorders, parotid inflammatory diseases, and intrinsic masseter muscle myopathy. A thorough clinical examination, combined with imaging results, helps in making an accurate differential diagnosis.
By following these diagnostic steps, healthcare providers can accurately identify masseter hypertrophy and rule out other potential causes of facial swelling. Early detection and effective treatment can significantly enhance patients' quality of life, addressing both functional impairments and cosmetic concerns associated with masseter hypertrophy.
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Treatment of masseter hypertrophy
Masseter muscle prominence, a condition characterized by an enlarged or hypertrophic masseter muscle, can be treated through a variety of methods, including behavioral, dental, and surgical approaches. Here is an overview of some of the common treatment options:
Behavioral and Dental Treatments:
- Behavioral interventions: These focus on addressing parafunctional habits, such as teeth grinding (bruxism) or jaw clenching, which are often associated with masseter muscle prominence. Patients are educated about the impact of these habits and are taught techniques to reduce or eliminate them. This may include stress management, awareness training, and behavioral therapy.
- Occlusal splints or night guards: Custom-made oral appliances, such as occlusal splints or night guards, can be worn during sleep to prevent teeth grinding and reduce the load on the masseter muscle. These appliances create a physical barrier between the teeth, helping to relax the jaw muscles and providing protection from the damaging effects of bruxism.
- Botox injections: Botox (botulinum toxin) injections can be used to temporarily weaken the masseter muscle and reduce its size. The injections are administered directly into the muscle, causing it to relax and soften. This treatment is often effective in reducing the appearance of a prominent masseter and can also help alleviate associated symptoms such as jaw pain and headaches.
Surgical Treatments:
- Masseter muscle reduction surgery: This surgical procedure involves making a small incision inside the mouth, through which the masseter muscle is carefully dissected and a portion of it is removed. This results in a reduction of the muscle bulk and a more slender jawline. The procedure is typically performed under local anesthesia and may require multiple sessions for optimal results.
- Bichectomy: While not directly targeting the masseter muscle, a bichectomy, or buccal fat removal, can help reduce fullness in the lower cheek area and improve the contour of the jawline. This procedure involves the surgical removal of the buccal fat pads, which are located between the masseter muscle and the oral mucosa.
It is important to note that the treatment approach may vary depending on the underlying cause of masseter muscle prominence and the patient's individual needs. A comprehensive evaluation by a qualified healthcare professional, such as a maxillofacial surgeon or a dentist specializing in facial aesthetics, is essential to determine the most appropriate treatment plan.
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Botox treatment for masseter hypertrophy
Masseter muscle hypertrophy refers to the enlargement of the masseter muscle, which is one of four pairs of muscles used for chewing. This condition can cause a square-shaped jawline, leading to a more masculine appearance in female patients and a bottom-heavy look in both male and female patients. It can also cause jaw asymmetry and discomfort. While the exact cause of masseter muscle hypertrophy is unknown, it is often associated with emotional stress, chronic clenching or grinding, gum chewing, and other habits that can lead to overworked masseter muscles.
Botox treatment, or botulinum toxin type A injection therapy, is a conservative, non-surgical approach to treating masseter hypertrophy. It involves injecting freeze-dried botulinum toxin protein, reconstituted with sterile saline, directly into the muscle to reduce muscle contractions. This treatment method is minimally invasive and can be an alternative to surgical procedures such as partial removal of the masseter muscle and jawbone or liposuction.
Several studies have explored the impact of Botox injections on masseter hypertrophy. A 2014 study by Klein et al. examined lower facial remodelling with botulinum toxin type A, while a 2010 study by Kim et al. focused on botulinum toxin type A for the treatment of masseter hypertrophy. A randomised, triple-blinded clinical trial by Balanta-Melo et al. assessed the effectiveness and functional adverse effects of single and multiple injections of botulinum toxin type A. This trial found that a single injection of a low dose had a positive effect on masseteric hypertrophy, but repeated injections at shorter intervals could lead to impaired masticatory performance and muscle activity, as well as a permanent decrease in muscle thickness.
The number of injections and dosage of Botox can vary depending on the case. A 2018 case report by Yeh et al. described a sequence of three injections to the left masseter (25 units in 1 cc of onabotulinumtoxinA) with EMG guidance. The initial treatment lasted for three months, and the second injection was more durable, but a third injection was warranted after one year. Another case report by Kwon et al. in 2019 described a 26-year-old male with masseteric hypertrophy Type II who underwent Botox injections as a non-surgical and minimally invasive therapeutic approach. The 6-point injection technique, where botulinum toxin is injected into six equidistant bulging points on the masseter, has also been found to be effective in reducing masseteric bulk.
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Frequently asked questions
Humans have two masseter muscles, one on each side of the face, which are used for chewing.
Masseter muscle prominence, or hypertrophy, refers to the enlargement of the masseter muscle. This can be caused by emotional stress, chronic clenching or grinding, gum chewing, or a preference for chewing on one side.
Masseter muscle prominence can be treated with splint therapy, behaviour therapy, or Botulinum toxin type A (Botox) injection therapy.
The traditional method of treating masseter muscle prominence is to surgically remove part of the masseter muscle and jawbone or to perform liposuction of the fat near the muscle.
