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Year : 2022  |  Volume : 17  |  Issue : 1  |  Page : 126-128

Bilateral masseter muscle hypertrophy

Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

Date of Submission13-Jan-2022
Date of Decision22-Feb-2022
Date of Acceptance08-Mar-2022
Date of Web Publication25-Jul-2022

Correspondence Address:
Dr. Pragati Anupkumar Bhargava
Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_252_22

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Masseter muscle hypertrophy is due to oral parafunctional habits, occlusal disharmony, altered emotional and psychological status, and at times congenital factors. Masseter muscle hypertrophy occurs usually at puberty involving unilateral or bilateral masseter muscles and affects functional quality in a severely hypertrophied muscle. This presents a report of a 14-year-old girl with bilateral masseter hypertrophy which compromised the esthetic value of the face. The diagnosis was made using clinical examination, conventional radiography, and magnetic resonance imaging.

Keywords: Anxiety, esthetic value, masseter hypertrophy

How to cite this article:
Bhargava PA, Bhowate RR, Badki SD, Meshram MG, Sune RV. Bilateral masseter muscle hypertrophy. J Datta Meghe Inst Med Sci Univ 2022;17:126-8

How to cite this URL:
Bhargava PA, Bhowate RR, Badki SD, Meshram MG, Sune RV. Bilateral masseter muscle hypertrophy. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 16];17:126-8. Available from: http://www.journaldmims.com/text.asp?2022/17/1/126/352224

  Introduction Top

Masseter muscle hypertrophy was first reported in the literature by Legg in 1880.[1] Masseter hypertrophy is a rare condition, may be due to congenital reason and some authors claim that defective function of masticatory apparatus which is associated with stress and anxiety.[2],[3] Altered and bulky masseter muscle hypertrophy is responsible for changes in bony morphology of the ascending ramus which leads to esthetic and functional problems.[3],[4] Cosmetic problem is usually because of bulky and prominent masseter muscles, making the facial appearance square shaped.[5] In cases with unknown etiology of masseter hypertrophy, may be responsible for altered psyche of an individual and leads to parafunctional oral habits.

  Case Report Top

An anxious 14-year-old girl reported to the Department of Oral Medicine and Radiology at Sharad Pawar Dental College and Hospital with the chief complaint of poor esthetics due to painless bulging at the right and left sides of the angle of mandible. Prenatal and postnatal history was noncontributory. There was no history of bruxism, clenching, or any other deleterious oral habits present without functional problems. Extraoral examination revealed a bilateral diffuse swelling extending from the angle of mandible up to the mid-surface of ascending ramus with normal overlying skin [Figure 1]a and [Figure 1]b. On palpation, soft tissue swelling was present bilaterally without local rise of temperature. On clenching, nontender four stout and firm muscle bulges were present on the left side and two on the right side. There was pronounced mentalis prominence on the right side [Figure 1]c. TMJ examination showed mandibular deviation toward the right side while opening, without any crepitus or popping sound and tenderness. Intraoral examination revealed palatal eruptions with 12, 13 and 22, 23 with over-retained 53, 55, 63, and 65. Mandibular arch examination revealed lingual eruptions of 33 and 43 with over-retained 73, 75, and 85, and there was dental and skeletal shift of midline toward the right side. Panoramic radiograph showed developing maxillary and mandibular second premolars with over-retained 53, 55, 63, 65, 73, 75, and 85. Vertical height of the ascending rami was reduced on both sides giving square shape to the jaw [Figure 2]. Magnetic resonance imaging (MRI) examination showed hypertrophy of medial pterygoid and both masseter [Figure 3]. The clinical and imaging characteristic favors bilateral idiopathic masseter hypertrophy. The patient and parents were counseled and assured regarding the benign nature of the disease and the possible definite treatment will be initiated after cessation of somatic growth.
Figure 1: (a and b) Prominent bulge of the right and left masseter. (c) Prominent bulge of the right mentalis

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Figure 2: Panoramic radiograph showing reduced vertical height of ramus bilaterally

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Figure 3: Magnetic resonance imaging T1 image showing hypertrophied masseter muscle bilaterally

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  Discussion Top

The masseter muscle occupies the lateral surface of the ascending ramus and adds to the facial esthetics. Masseter hypertrophy is a benign which increases in size and shape of the muscle with rare occurrence affecting the esthetic value of the face.[6] Detailed clinical examination, panoramic radiograph, and other supplementary imaging methods are helpful for the diagnosis of masseter muscle hypertrophy. Muscle palpation in relax position locate the intramuscular increase in size and clenching helpful in identifying total increase in the size of masseter muscle. More than 130 cases were reported in the literature, and age of initiation of masseter hypertrophy mainly reported in the second decade of life; most commonly, it affects male predominantly than females with age of occurrence of second decade.[6] Bruxism, occlusal disharmony, teeth clenching, and other parafunctional oral habits may be responsible for the muscle hypertrophy, or in case of idiopathic muscular hypertrophy, change in psyche of an individual adds to the severity of masseter hypertrophy along with esthetic appearance.[7] Rispoli DZ et al. classified masseter hypertrophy either congenital or familial and acquired which is most of the time functional hypertrophy.[8] Conventional panoramic radiograph reveals squaring of ascending ramus due to muscle hypertrophy, but computed tomography reports quality and structure of the bone, while MRI will help in identifying the overall soft tissue enlargement and high-intensity signals in the affected muscle.[9] Soft tissue evaluation by ultrasonographic imaging helps in determining overall volume, and electromyography recording will help in determining muscle activity.[10] Parotid enlargement, fibroma, lipoma, lipofibroma, dermatomyositis, and deep-seated vascular tumors are included in differential diagnoses. In benign muscular hypertrophy, psychological counseling is the mainstay of treatment protocol and categorized into surgical and nonsurgical treatment modalities. In case of oral parafunctional habits and occlusal disharmony, mouth guards, oral physiotherapy, and correction of occlusion along with muscle relaxant and anxiolytic drugs may be helpful in reducing the hypertrophied muscle bulk. Local injection of botulinum-A toxin is safe and less invasive in masseter hypertrophy is responsible for local paralysis of individual muscle because of its action on neuromuscular tissue causing atrophy of the muscle and helpful in reducing the hypertrophic muscle bulk.[9] The main disadvantage of botulinum toxin is reversal of the achieved debulking in 6 months. Surgical intervention includes partial removal of excessive and hypertrophied deep masseter fibers, and osteoplasty is accompanied where there is bony hyperplasia of the mandible angle.[9]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Legg JW. Enlargement of the temporal and masseter muscles on both sides. Trans Pathol Soc (Lond) 1880;31:361-6.  Back to cited text no. 1
Kebede B, Megersa S. Idiopathic masseter muscle hypertrophy. Ethiop J Health Sci 2011;21:209-12.  Back to cited text no. 2
Tabrizi R, Ozkan BT, Zare S. Correction of lower facial wideness due to masseter hypertrophy. J Craniofac Surg 2010;21:1096-7.  Back to cited text no. 3
Yoda T, Sato T, Abe T, Sakamoto I, Tomaru Y, Omura K, et al. Long-term results of surgical therapy for masticatory muscle tendon-aponeurosis hyperplasia accompanied by limited mouth opening. Int J Oral Maxillofac Surg 2009;38:1143-7.  Back to cited text no. 4
Özkan BT, Tabrizi R, Cigerim L. Management of bilateral masseter muscle hypertrophy. J Craniofac Surg 2012;23:e14-6.  Back to cited text no. 5
Sannomya EK, Gonçalves M, Cavalcanti MP. Masseter muscle hypertrophy: Case report. Braz Dent J 2006;17:347-50.  Back to cited text no. 6
Mandel L, Kaynar A. Masseteric hypertrophy. N Y State Dent J 1994;60:44-7.  Back to cited text no. 7
Shetty N, Malaviya RK, Gupta MK. Management of unilateral masseter hypertrophy and hypertrophic scar – A case report. Case Rep Dent 2012;2012:521427.  Back to cited text no. 8
Rispoli DZ, Camargo PM, Pires JL Jr., Fonseca VR, Mandelli KK, Pereira MA. Benign masseter muscle hypertrophy. Rev Bras Otorrinolaringol 2008;74:790-3.  Back to cited text no. 9
Singh S, Shivamurthy DM, Agrawal G, Varghese D. Surgical management of masseteric hypertrophy and mandibular retrognathism. Natl J Maxillofac Surg 2011;2:96-9.  Back to cited text no. 10
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