Cavernous haemangioma of the masseter muscle: transoral approach.

Intramuscular haemangiomas (IH) are rare lesions, accounting for less than 1% of all haemangiomas. This article presents the case of a woman in her 40s with a swelling in her left cheek. CT revealed an intramuscular lesion within the masseter, suggestive of a venous malformation. Surgical treatment was carried out with intraoral access to the lesion, allowing for complete removal, resulting in temporary swelling and trismus. There was no facial paralysis. We discuss information on IH in the head and neck and their surgical approaches.

Masseter muscle flap for reconstruction of intra-oral defects in patients with early cancer of posterior-inferior parts of the oral cavity.

INTRODUCTION: Early carcinomas of the oral cavity in the posterior-inferior regions poses a challenge for reconstruction due to the lack of muscle support underneath and the limited space available to use some of the frequently-used flaps. OBJECTIVE: This study was done to evaluate the efficacy of the superiorly based masseter muscle flap in reconstruction of intra-oral post- ablation defects in patients with early oral carcinoma of the posterior-inferior part of the oral cavity. METHODS: A superiorly based masseter muscle flap were used to reconstruct the post-surgical intra- oral defect in 60 patients with early squamous cell carcinoma (T<4cm) of the posterior-inferior part of the oral cavity. The patients were followed up at 1-week and 1-month postoperatively to check for flap viability, complications, change in mouth opening and deviation of the mandible on mouth opening. To rule out any recurrence in the oral cavity masseter flaps, the patients were followed up for 1 year. RESULTS: The flap was viable in all patients and underwent mucosalization. 7/60 patients had postoperative infections, while 2/60 patients developed an oro-cutaneous fistula which required a secondary corrective procedure. The mean±standard deviation of change in mouth opening at 1 week postoperatively was +1.917±3.36mm, which increased to +2.633±2.95mm at 1 month after surgery. The Friedman test revealed that there was a statistically significant change in mouth opening from preoperative period to the1 week and 1 month postoperative periods (p=0.000). Female patients showed better improvement in mouth opening postoperatively. The ipsilateral deviation of the mandible on mouth opening was between 0-5mm in 39 patients, 5-10mm in 17 patients and more than 10mm in 4 patients. There were no recurrences noted in the masseter flaps used. CONCLUSION: The study infers that the superiorly based masseter muscle flap is a reliable method for reconstruction in early oral cancer patients yielding good functional results and acceptable cosmesis with nominal postoperative complications.

Surgical Resolution of Bilateral Hypertrophy of Masseter Muscle Through Intraoral Approach.

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.

Diagnostic approach to intramasseteric nodules.

Intramuscular nodules can be the clinical presentation of several groups of lesions, such as reactive disorders and benign and malignant tumors. Here, we present three cases with similar clinical features and image aspects on Doppler ultrasonography. Two of the lesions were diagnosed as intramasseteric hemangioma and the third as intramasseteric metastasis from high-grade pleomorphic sarcoma of the thigh. The diagnosis of intramasseteric nodules is challenging, and various differential diagnoses must be considered. Clinical features, evolution time, and information from complementary examinations, such as Doppler ultrasonography and fine-needle aspiration cytology, are useful in making a precise diagnosis and providing appropriate treatment.

Reduction and fixation of mandibular condylar fractures with neck screw.

PURPOSE: The purpose of the present study is to describe a surgical technique for the treatment of condylar fractures using an intramedullary screw. MATERIALS AND METHODS: The treatment of these fractures remains very controversial. At the time of the choice of the surgical treatment, a wide range of accesses and of techniques of reduction and fixation is used, depending on the type of the fracture, the experience of the surgeon, and aesthetical issues. Among the difficulties posed by this type of fracture is the correct repositioning of the fractured condylar portion for which we have developed a technique that uses a neck screw, with intramedullary insertion. Because this is a round-headed screw, it is necessary to install a plate, which may be straight or "L" shape, and is placed perpendicular and superjacent to the screw so that it does not allow the rotation of the condylar portion. RESULTS: Neck screw can be used, resulting in satisfactory stability, for the reduction and fixation of these fractures.

Effects of the unilateral removal and dissection of the masseter muscle on the facial growth of young rats.

This study analyzed the effects of the unilateral removal and dissection of the masseter muscle on the facial growth of young rats. A total of 30 one-month-old Wistar rats were used. Unilateral complete removal of the masseter muscle was performed in the removal group, and detachment followed by repositioning of the masseter muscle was performed in the dissection group, while only surgical access was performed in the sham-operated group. The animals were sacrificed at three months of age. Axial radiographic projections of the skulls and lateral projections of the hemimandibles were taken. Cephalometric evaluations were made and the values obtained were submitted to statistical analyses. In the removal group, there were contour alterations of the angular process, and a significant homolateral difference in the length of the maxilla and a significant bilateral difference in the height of the mandibular body and the length of the mandible were observed. Comparison among groups revealed significance only in the removal group. It was concluded that the experimental removal of the masseter muscle during the growing period in rats induced atrophic changes in the angular process, as well as asymmetry of the maxilla and shortening of the whole mandible.

Effects of the unilateral removal and dissection of the masseter muscle on the facial growth of young rats

This study analyzed the effects of the unilateral removal and dissection of the masseter muscle on the facial growth of young rats. A total of 30 one-month-old Wistar rats were used. Unilateral complete removal of the masseter muscle was performed in the removal group, and detachment followed by repositioning of the masseter muscle was performed in the dissection group, while only surgical access was performed in the sham-operated group. The animals were sacrificed at three months of age. Axial radiographic projections of the skulls and lateral projections of the hemimandibles were taken. Cephalometric evaluations were made and the values obtained were submitted to statistical analyses. In the removal group, there were contour alterations of the angular process, and a significant homolateral difference in the length of the maxilla and a significant bilateral difference in the height of the mandibular body and the length of the mandible were observed. Comparison among groups revealed significance only in the removal group. It was concluded that the experimental removal of the masseter muscle during the growing period in rats induced atrophic changes in the angular process, as well as asymmetry of the maxilla and shortening of the whole mandible.

A intervenção fonoaudiológica no pós-operatório da hipertrofia benigna do músculo masseter / The miofunctional oral intervention in the surgery treatment for the masseter muscle hipertrophy

OBJETIVO: descrever a abordagem fonoaudiológica no pós-operatório de pacientes que realizaram correção cirúrgica da hipertrofia do músculo masseter. METODOLOGIA: foram coletados dados referentes à avaliação e ao tratamento fonoaudiológico de 4 prontuários de sujeitos de ambos os gêneros, com faixa etária entre 16 e 24 anos, com hipertrofia benigna do músculo masseter, tratados cirurgicamente. RESULTADOS: as principais queixas pós-cirúrgicas estiveram relacionadas à limitação da abertura da boca, à dor na região da cirurgia, à rigidez muscular e a estalo em região da ATM. A terapia fonoaudiológica baseou-se em orientação quanto à retirada de hábitos deletérios; termoterapia na região do músculo masseter; manipulação da musculatura envolvida extra e intrabucais; alongamento da musculatura facial e cervical; alavanca de abertura forçada de boca e exercícios de órgãos fonoarticulatórios. CONCLUSÕES: a terapia fonoaudiológica apresenta-se como uma possibilidade de complementação ao tratamento cirúrgico, na adequação da amplitude dos movimentos mandibulares, assim como na eliminação dos sintomas presentes no pós-cirúrgico e na conscientização dos hábitos deletérios, que são apontados pela literatura como possíveis fatores desencadeantes.

Miectomia com acesso extraoral para hipertrofia benigna de Masseter: relato de caso / An extraoral approach for miectomy in Masseter muscle hipertrophy: case report

A hipertrofia benigna de masseter é uma patologia caracteriza por um abaulamento indolor da região de ângulo mandibular, podendo ser uni ou bilateral. O diagnóstico é exclusivamente clínico, confirmado durante o ato operatório. O presente trabalho apresenta um caso de hipertrofia benigna de Masseter tratado cirurgicamente com miectomia por acesso extra-oral, onde o resultado foi satisfatório, com controle de três anos sem recidiva. Além dessa modalidade de tratamento, a hipertrofia benigna de masseter pode ser tratada com outras técnicas cirúrgicas ou modalidades conservadoras. A comparação da eficácia entre as diferentes técnicas é discutida no presente trabalho

Hipertrofia do masseter: relato de caso / Masseteric hypertrophy: report of a case

A hipertrofia do músculo masseter é definida como um crescimento excessivo desta musculatura, relativamente incomum, de origem indefinida e que pode ser tratada através de métodos cirúrgicos e não-cirúrgicos. O tratamento cirúrgico envolve intervenções que são realizadas, apenas, na musculatura comprometida, na estrutura óssea do ângulo mandibular ou na associação de ambos os procedimentos. Neste trabalho, relatou-se um caso clínico tratado cirurgicamente por intervenção apenas óssea e discutiu-se a etiopatogenia, o diagnóstico e o tratamento desse tipo de hipertrofia.

A transparotid transcutaneous approach for internal rigid fixation in condylar fractures.

Closed versus open reduction in condyle fractures is a dilemma that may torment the plastic surgeon. Although at present it is accepted that there are fractures that must be open reduced as when the middle cranial fossa or temporal fossa are involucrated, foreign body are in the joint capsule, lateral extracapsular deviation of condylar deviation, and open fractures. Risdon or retromandibular approaches are used for the treatment of fractures in the condyle neck and superior third of the lower ramus.When both approaches are used the correct placement of screws is very difficult for the following reasons: 1. Both drill and screwdrivers must be placed in an oblique direction to the bone surface; as a result, screws do not press the plate toward the bone and therefore a deficient stabilization results; 2. A distraction of too much soft tissue entrapped between the skin and mandibular bone is necessary for a good visual to surgical field and 3. The parotid tissue, the masseter muscle, and the facial nerve must be strongly distracted facilitating the nerve injury.A transcutaneous transparotid approach is the most appropriate for screws placement. By means of transbuccal set it is possible to reach the mandibular bone going through both the parotid tissue and the masseter muscle avoiding the injury the branches of the facial nerve.A case report illustrates the practical application of the above technique and it shows that as the lesion of branches of the facial nerve can be avoided.

Correção cirúrgica da hipertrofia de masseter / Surgical correction of masseter muscle hypertrophy

A hipertrofia de masseter é uma entidade benigna que pode apresentar envolvimento uni ou bilateral, sendo comumente assintomática. A etiologia ainda é desconhecida, porém, fatores como bruxismo, apertamento dental, desordens internas da articulação temporo-mandibular e trauma são considerados como possíveis agentes etiológicos. O diagnóstico é basicamente clínico, sendo que exames radiográficos contribuem para a identificação de envolvimento ósseo ao nível de ângulo mandibular. O tratamento pode ser cirúrgico ou conservador. O presente trabalho tem como objetivo relatar 41 casos de hipertrofia de masseter em 22 pacientes operados no Setor de Cirurgia e Traumatologia Buco-Maxilo-Facial do Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, no período correspondente entre março de 1998 a setembro de 2000. Dentre os pacientes operados não foi diagnosticado nenhum caso de infecção e apenas três pacientes evoluíram com assimetria no pós-operatório tardio, sendo que a correção cirúrgica de masseter foi considerada um procedimento viável e adequado para o tratamento desta entidade

Efeitos da remoção das fibras dorso-caudais do músculo masseter sobre o crescimento do osso zigomático em mini-porcos (SusScrofa) / The effects of dorso-caudal fibers removal from masseter muscle affects the growth of zigomatic bone in mini-pics (Sus scrofa)

A ação das forças musculares sobre os óssos ainda não está totalmente esclarecida, principalmente porque a maior parte dos estudos realizados utilizou modelos experimentais pouco controlados. Por outro lado, o arco zigomático de mini-porcos (Sus scrofa) apresenta características anatômicas e fisológicas bastante próprias para verificar o efeito da ação muscular sobre o osso. Utilizando-se portanto este modelo, investigou-se no presente trabalho, se a remoção de parte do músculo masseter afetaria a estrutura e o crescimento da franja zigomática. O material consistiu de 3 mini-porcos que tiveram a região dorso-caudal do masseter removida cirurgicamente e servindo como controle, 3 mini-porcos da mesma idade. Foram analisados então os seguintes parâmetros: (1) forma do osso zigomático em níveis macro e microscópicos por métodos morfométricos; (2) acompanhamento da direção do crescimento ósseo através de radiografias padronizadas sequenciais e implantes metálicos; (3) eletromiografias semanais dos músculos envolvidos; (4) análise funcional e quantitativa da mastigação em imagens de vídeo; e (5) densidade volumétrica das trabéculas ósseas e taxa de crescimento ósseo aposicional, através de avaliação histológica, utilizando a marcação óssea por tetraciclina. Os resultados mostraram que: (1) o padrão muscular foi alterado; (2) não houve atividade na região da extirpação muscular; (3) houve uma diminuiçao significativa (p<0,001) no comprimento dorso-ventral da franja zigomática no grupo experimental; e (4) a densidade trabecular e taxa de crescimento não apresentaram diferenças significativas. Esses resultados indicam que há um limitado, porém claro efeito da musculatura esquelética sobre a forma do osso

Temporoparietal-occipital flap for facial reconstruction.

Eight patients with an extensive facial defect of the masseter region were reconstructed with a temporoparietal- occipital rotation flap. This flap is vascularized by both the arteria auricularis posterior and the arteria occipitalis lateralis. These vessels have been sufficient to ensure viability of the entire flap. It is elevated and easily transposed to the masseter region because of the distensibility obtained from the posterior neck. This approach avoided the need for an unsightly skin graft at the site while providing tissue with hair follicles that blend well with the surrounding hair. This large flap offers cosmetic advantages over other techniques for coverage of facial defects in men.

Anatomía quirúrgica del músculo masetero y su aplicación en la cirugía bucomaxilofacial / Surgical anatomy of the masseter muscle and its application to oral and maxillofacial surgery

El músculo masetero (del griego maseteero = masticador) craneomandibular inervado por el nervio trigémino, pose gran participación en la dinámica mandibular. Su excelente irrigación lo ha convertido en un colgajo de enorme importancia en la cirugía reconstructiva bucomaxilofacial. El objetivo del siguiente trabajo es presentar una detallada y seleccionada revisión bibliográfuca sibre y una base obtenida de los textos clásicos, con el aporte de nuevos conceptos establecidos en artículos recientemente publicados acerca de la irrigación y técnicas quirúrgicas. Se describen la anatomía quirúrgica del músculo masetero, las indicaciones para la utilización de su colgajo y la variabilidad de opciones que el mismo presenta, realizándose en cadáveres formolizados la reproducción de las téccnicas más sobresalientes, adjuntas a su correspondiente descripción

Estudio clínico de la hipertrofia maseterina / Clinical study of masseter hypertrophy

La hipertrofia maseterina es una condición que presentan algunos pacientes que acuden a la consulta odontológica. En muchas ocasiones son referidos por ser confundidos con una tumoración de glándulas salivales o de los maxilares, sobre todo las unilaterales. El odontólogo muchas veces se sorprende frente a esta condición que, en la mayoría de los casos, está acompañada de hábitos indeseables como masticar exagerado, el bruxismo y trastornos sicológicos asociados al estrés. Se hace una revisión de la literatura y se presenta un estudio clínico de los pacientes que asisten al servicio de postgrado de Cirugía Bucal de la Facultad, donde se encontró gran relación entre la hipertrofia maseterina clínica y el hábito del bruxismo; igualmente llama la atención el grupo etario de estos pacientes en la 2da y 3ra década de la vida. Se ofrece un aporte al conocimiento de los músculos masticatorios, en este caso del músculo masetero con una condición que prsenta relativa frecuencia de hipertrofia maseterina

End results of 114 extended "commando" operations for retromolar trigone carcinoma.

Retromolar trigone carcinomas invade the mandible and the pterygoid and/or masseter muscles in a large number of cases. There is also a significant risk of ipsilateral lymph node neck metastasis. The purpose of this retrospective study was to report the survival results of 114 consecutive patients who underwent an extended "commando" operation (retromolar operation) from 1960 to 1991. The technique is a variation of a composite resection. The operation consists of hemimandibulectomy with resection of the pterygoid and masseter muscles, with an ipsilateral neck dissection (radical classical, modified, or supraomohyoid). The oral cavity and oropharyngeal defects were closed primarily in 83 patients. In the remaining 31 patients (27.2%), it was reconstructed by a tongue flap (12 patients), pectoralis major myocutaneous flap (10 patients), and other flaps (9 patients). There were 104 men and 10 women, with a median age of 55 years. All patients had squamous cell carcinoma. Tumor stages were T1 (5 patients), T2 (44 patients), T3 (24 patients), T4 (28 patients), and Tx (13 patients). The metastases were predominantly in levels I and II. Only patients with positive nodes at levels I and/or II had histologically positive nodes at levels IV or V. Complications occurred in 51.8% of the patients (wound infection in 21 patients, 18.4%). Sixty-six patients underwent postoperative irradiation (4 to 70 Gy, median: 50 Gy). To date, 41 patients have presented with 50 tumor recurrences: 31 local, 9 in the dissected neck, 3 in the contralateral neck, and 7 distant. The 5-year actuarial overall survival rate was 80.0% in patients with T1 tumors, 57.8% in those with T2 tumors, 46.5% in those with T3 tumors, and 65.2% in those with T4 tumors. In conclusion, the retromolar operation can be performed with acceptable morbidity, and it is effective (5-year overall survival rate of 55.3%). The rate of local recurrences (27.2%) suggests that radiotherapy as an adjunctive modality should be indicated in patients in whom recurrences are likely.

Estudo, pela microscopia eletrônica de varredura, da compacta óssea da mandíbula do coelho após a remoçäo do músculo masséter / Scanning electron microscopy study of the compact bone of the rabbit mandible following the masseter muscle removal

Com a finalidade de se estudar modificaçoes estruturais do tecido ósseo devido à diminuiçao de forças tensoras incidentes sobre ele, foi praticada a remoçao cirúrgica unilateral do músculo masséter em quatro coelhos adultos. Seis meses após, os animais foram sacrificados e o osso em questao foi preparado para ser examinado ao microscópio eletrônico de varredura. A superfície da compacta óssea do lado operado sofreu modificaçoes caracterizadas pela reduçao das superestruturas nos locais de forte inserçao muscular, e pelo aparecimento de áreas de reabsorçao e de grande quantidade de forames vasculares, além de certa desorganizaçao dos feixes colágenos calcificados.

[Biprotrusion]. / La biprotrusion.

The clinic characteristics of the biprotrusion are here of described together with the associate alterations, the maseteric an gonic hyperplasia, and the corresponding treatment. As an example what has been previously said is illustrated with the excellent result shown in a patient.