What Are My Options For Fixing Masseteric Muscle Disinsertion?

Q: Dr. Eppley, I was wondering if you provide surgical and non surgical treatments to fix masseter muscle disinsertion. I had a custom jaw implant but the shape has come out round because of the muscle not filling the gonial. I heard Botox can be used and then guided to fill the gonial area. Have u had any experience with this and what would be the cost of you surgical treatment . Thank you 

A: The cause of masseter muscle disinsertion (MMD) is either inadvertent separation of the psteryomasseteric sling during implant placement or an implant design that extends too far back beyond the muscle border. (which is an implant design issue and is better known as ‘implant reveal’. I do not understand the statement ‘ the shape has come out round because of the muscle not filling the gonial’ as the muscle is not what causes the implant shape at the angle.

In the treatment of true masseter muscle disinsertion (MMD)the fundamental options are to either 1) cover the exposed implant and 2) reduce the size of the muscle above it with Botox injections. (a short term but not a long term solution) #2 is a temporary non-surgical solution,. There is no such thing as ‘ I heard Botox can be used and then guided to fill the gonial area.‘ Botox is a muscle reducer not a soft tissue filling material.

In the surgical treatment of MMD them options are 1) muscle repositioning back over the implant, 2) fat injections over the implant, 3) alloderm grafts or synthetic soft tissue jaw angle implants. I have done them all and each of these methods has their distinct advantages and disadvantages.

Dr. EppleyDr. Barry Eppley

Indianapolis, Indiana