Can Jaw Angle Implants Disrupt The Masseter Muscle?
Q: Dr. Eppley, I had a question concerning the jaw implant implants. I read a recent article which talked about disruption of the masseter muscle following jaw implant surgery due to disruption of the pterygomasseteric sling. The article talked about how the muscle could retract up and cause problems. Is this a complication you have seen often? Or is there some technique you have for preventing this?
A: In placing jaw angle implants, it is a submuscular/subperiosteal implant location over the ramus (jaw angle) of the mandible. These tissues must be lifted up to insert the implants. The masseter muscle wraps around the mandible and creates the pterygomasseteric sling. (muscle on both sides of the mandible) Thus when lifting up the muscle along the bottom edge of the bone it is possible to disrupt/tear this sling where it is the thinnest/weakest. If the muscle is completely torn along its entire length when it is being raised. If this happens it is possible that the masseter muscle will retract and could be seen as a bulge above the lower border of the implant.
While I have seen this potential issue discussed/written about, it is not a phenomenon in jaw angle implants or fracture repair or sagittal ramus osteototmies that I have ever seen. (all jaw operations that separate the pterygomaseeteric sling from the bone) The key in elevating this tissue is to do it gently and with attention to not tearing the muscle.
Dr. Barry Eppley