21296 Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); intraoral approach

Name of the Procedure:

Reduction of Masseter Muscle and Bone (e.g., for treatment of benign masseteric hypertrophy); intraoral approach

Summary

This surgical procedure aims to reduce the size of the masseter muscle and underlying bone through an incision made inside the mouth. It is typically performed to address excessive growth of the masseter muscle that leads to a square jaw appearance.

Purpose

This procedure addresses benign masseteric hypertrophy, a condition characterized by the overgrowth of the masseter muscle, which can cause an overly prominent jawline. The goals include improving facial aesthetics, reducing discomfort or pain associated with muscle hypertrophy, and improving the symmetry of the jawline.

Indications

Patients experiencing the following may benefit from this procedure:

• Cosmetic concerns due to a prominent or square jawline
• Facial asymmetry due to masseter muscle overgrowth
• Discomfort or pain related to benign masseteric hypertrophy

Criteria for the procedure may include:

• Diagnosed benign masseteric hypertrophy
• Patient dissatisfaction with facial appearance due to muscle hypertrophy
• No underlying malignancy or other contraindications for surgery

Preparation

• Patients may be required to fast for 8-12 hours before the procedure.
• Discontinuation or adjustment of certain medications as advised by the surgeon.
• Pre-operative imaging or tests to assess the extent of muscle and bone hypertrophy.

Procedure Description

1. The procedure is performed under general anesthesia.
2. An incision is made inside the mouth, along the inner cheek surface, to access the masseter muscle.
3. The surgeon carefully reduces the size of the masseter muscle.
4. If bone reduction is necessary, a portion of the jawbone may be shaved or trimmed.

5. The incision is then closed with dissolvable sutures.

   Tools and equipment may include surgical scalpels, bone saws or burrs, and suturing materials.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

The procedure is performed in a hospital surgical suite or an accredited outpatient surgical center.

Personnel

The surgical team usually includes a plastic or maxillofacial surgeon, an anesthesiologist, operating room nurses, and surgical assistants.

Risks and Complications

Common risks include:

• Infection
• Bleeding or hematoma
• Swelling and bruising

Rare risks or complications may include:

• Nerve damage leading to facial numbness or weakness
• Asymmetry or dissatisfaction with aesthetic results
• Delayed healing or scarring

Benefits

• Enhanced facial aesthetics with a more balanced and refined jawline
• Relief from discomfort or pain associated with muscle hypertrophy

• Improved self-esteem and confidence

  Benefits can generally be observed within a few weeks, as swelling subsides.

Recovery

• Patients are typically advised to follow a soft diet for a few weeks.
• Oral hygiene measures including antiseptic mouthwash to prevent infection.
• Swelling and bruising may persist for several weeks.
• Follow-up appointments are necessary to monitor healing and results.
• Avoid strenuous activity for at least 2-4 weeks.

Alternatives

Alternative treatments may include:

• Botulinum toxin (Botox) injections to temporarily reduce muscle size
• Orthognathic (jaw) surgery for functional and aesthetic corrections
• Non-surgical facial contouring treatments

Each alternative has its own benefits and limitations, with non-surgical options being less invasive but not permanent.

Patient Experience

During the procedure, the patient will be under general anesthesia and thus will not feel any pain. Post-procedure, patients might experience some discomfort, swelling, and bruising, manageable with prescribed pain medication and cold compresses. Eating and speaking might be initially challenging, but these issues typically resolve within a few days to weeks.