MASSETER BOTOKS ENJEKSİYONU SONRASI GELİŞEN PARADOKSAL BULGİNG FENOMENİ; VAKA SERİLERİ VE LİTERATÜR DERLEMESİ

Amaç: Mandibular eklem olarak da bilinen temporomandibular eklem (TME); dış kulak yolunun önünde mandibulayı temporal kemiğe bağlayan sinoviyal bir eklemdir. TME rahatsızlıkları toplumda sıklıkla görülmekle beraber; çiğneme kaslarından kaynaklanan bozukluklar, TME’de kondil ve disk uyumsuzlukları, inflamatuar eklem hastalıkları, kronik mandibular hipomobilite, konjenital ya da kazanılmış kas ve kemik rahatsızlıkları gibi birçok nedenden kaynaklanabilmektedir. Vaka raporları: Çalışmamızda eklem ağrısı şikayetleri ile Gazi Üniversitesi Diş hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi Kliniğine başvuran 4 hastanın teşhis ve tedavi süreci sunulmuştur. Olguların hepsinin bruksizme bağlı masseter hipertrofisinin olduğu tespit edildi. İşlem öncesi hastalardan yazılı olarak alınan aydınlatılmış onam sonrasında, botulinum toksin-A (BTA) uygulaması yapıldı. Uygulamanın sonrası yapılan kontrol muayenelerinde 4 olguda da paradoksal masseterik şişlik tespit edildi. Çalışmamızda sunulan hastaların botokstan etkilenmeyen masseter kaslarının yüzeyel loblarına daha yüzeyel bir botoks enjeksiyonu yapıldı, ortalama on gün içerisinde bütün hastalarda şikayetlerin ortadan kaktığı görüldü. Sonuç: Masseter botoksu sonrası paradoksal şişlik fenomeni nadir görülmekte olup, hekim tarafından doğru konulan teşhis sonrasında kolaylıkla tedavi edilebilmektedir. Bruksizm ve masseter hipertrofisi için botoks uygulamalarını yapan hekimlerinin ortaya çıkabilecek olası komplikasyonlarla ilgili bilgili sahibi olması ve gerekli çözümleri sunabilmesi gerekmektedir.

Anahtar Kelimeler:

Temporomandibular eklem, botoks, masseterik şişlik, paradoksal masseterik şişlik, bruksizm, Temporomandibular joint, botox, masseteric swelling, paradoxical masseteric bulging, bruxism

PARODOXICAL BULGING PHENOMENA AFTER MASSETER BOTOX INJECTIONS; CASE SERIES AND THE REVIEW OF THE LITERATURE

Aim: The temporomandibular joint (TMJ), also known as the mandibular joint; is a nearby the synovial joint that connects the mandible to the temporal bone the external auditory canal. Although TMJ disorders are frequently seen; they can be caused by many reasons such as disorders caused by masticatory muscles, condyle and articular disc incompatibility, inflammatory joint diseases, chronic mandibular hypomobility, and congenital or acquired muscle and bone disorders. Case reports: In our study, the diagnosis and treatment process of 4 patients who applied to the Gazi University Faculty of Dentistry Department of Oral and Maxillofacial Surgery clinic with complaints of TMJ pain were presented. All of the cases had masseter hypertrophy due to bruxism. Botulinum toxin-A (BTA) was injected to the masseter muscles bilateraly after written informed consents were obtained from each patients before the procedure. In the control examinations an unexpected paradoxical masseteric bulging was detected. A more superficial BTA injection was applied to the superficial lobe of the masseter muscles that was not affected by BTA in presented patients and the complaints were dissolved in ten days. Conclusions: The cases presented in our article have a rare complication of BTA injections and can be treated easily after a correct diagnosis by the physician. Physicians who perform BTA injections for bruxism and masseter hypertrophy should be aware of the possible complications and should have sufficient knowledge and experience to overcome it.

Keywords:

Temporomandibular joint, botox, masseteric swelling, paradoxical masseteric bulging, bruxism,

PDF

___

1. Buescher JJ. Temporomandibular joint disorders. Am Fam Physician. 2007;76(10):1477-82.
2. Solberg WK, Woo MW, Houston JB. Prevalence of mandibular dysfunction in young adults. Journal Am Dent Assoc. 1979;98(1):25- 34.
3. Gray RJM, Davies SJ, Quayle AA, Association BD. Temporomandibular disorders: a clinical approach: Ishiyaku Euroamerica; 1995.
4. Ingawale S, Goswami T. Temporomandibular joint: disorders, treatments, and biomechanics. Ann Biomed Eng. 2009;37(5):976-96.
5. Al-Ahmad HT, Al-Qudah MA. The treatment of masseter hypertrophy with botulinum toxin type A. Saudi Med J. 2006;27(3):397-400.
6. Fedorowicz Z, van Zuuren EJ, Schoones J. Botulinum toxin for masseter hypertrophy. Cochrane Database of Systematic Reviews. 2013(9).
7. Xie Y, Zhou J, Li H, Cheng C, Herrler T, Li Q. Classification of masseter hypertrophy for tailored botulinum toxin type A treatment. Plast Reconstr Surg. 2014;134(2):209e-18e.
8. Carruthers J, Fagien S, Matarasso SL. Consensus recommendations on the use of botulinum toxin type A in facial aesthetics. Plast Reconstr Surg. 2004;114(6):1S-22S.
9. Moore A, Wood G. The medical management of masseteric hypertrophy with botulinum toxin type A. Br J Oral Maxillofac Surg. 1994;32(1):26-8.
10. Kim J-H, Shin JH, Kim ST, Kim C-Y. Effects of two different units of botulinum toxin type a evaluated by computed tomography and electromyographic measurements of human masseter muscle. Plast Reconstr Surg. 2007;119(2):711-7.
11. Lee SJ, Kang JM, Kim YK, Park J, Kim DY. Paradoxical bulging of muscle after injection of botulinum neurotoxin type A into hypertrophied masseter muscle. J Dermatol. 2012;39(9):804-5.
12. Chirico F, Bove P, Fragola R, Cosenza A, De Falco N, Lo Giudice G, et al. Biphasic Injection for Masseter Muscle Reduction with Botulinum Toxin. Appl Sci. 2021;11(14):6478.
13. Rice SM, Nassim JS, Hersey EM, Kourosh AS. Prevention and correction of paradoxical masseteric bulging following botulinum toxin injection for masseter hypertrophy. Int J Women's Dermatology. 2021;7(5PB):815-6.
14. Liew S, Dart A. Nonsurgical reshaping of the lower face. Aesthet Surg J. 2008;28(3):251-7.
15. Kim HJ, Yum KW, Lee SS, Heo MS, Seo K. Effects of botulinum toxin type A on bilateral masseteric hypertrophy evaluated with computed tomographic measurement. Dermatol Surg. 2003;29(5):484-9.
16. Kim N-H, Park R-H, Park J-B. Botulinum toxin type A for the treatment of hypertrophy of the masseter muscle. Plast Reconstr Surg. 2010;125(6):1693-705.
17. Kim N-H, Chung J-H, Park R-H, Park J-B. The use of botulinum toxin type A in aesthetic mandibular contouring. Plast Reconstr Surg. 2005;115(3):919-30.
18. Lee H-J, Kang I-W, Seo KK, Choi Y-J, Kim S-T, Hu K-S, et al. The anatomical basis of paradoxical masseteric bulging after botulinum neurotoxin type A injection. Toxins. 2016;9(1):14.
19. Peng HLP, Peng JH. Complications of botulinum toxin injection for masseter hypertrophy: Incidence rate from 2036 treatments and summary of causes and preventions. J Cosmet Dermatol. 2018;17(1):33-8.
20. Lee H-J, Jung S-J, Kim S-T, Kim H-J. Ultrasonographic considerations for safe and efficient botulinum neurotoxin injection in masseteric hypertrophy. Toxins. 2021;13(1):28