Utilización combinada de la toxina botulínica y la terapia oclusal en el abordaje de la hipertrofia bilateral del músculo masetero. Caso clínico

Abstract

Introduction The etiology of this clinical condition is multifactorial and may be related to numerous processes such as bruxism, specific pathology of the temporomandibular joint, occlusion alterations, emotional disorders, chronic stress, absence of REM sleep, as well as a specific alteration in the modulation of acetylcholine and dopamine in the nociceptors and muscle neuroreceptors of one or both masseter muscles. The initial clinical manifestations are very variable, most of them are asymptomatic and are usually diagnosed after the patient perceives a variable bulge in the proximities of the mandibular angle. This anatomical modification and disfigurement can be perceived by the patient with greater or lesser intensity, depending on the variations in weight that he/she may experience during a short period of time. It should also be noted that not in all unilateral or bilateral masseter hypertrophies the application of botulinum tox- in is indicated, and that in some cases, it can lead to the undesirable circumstance of overtreatment, with the consequent masking of other pathologies that should have been diagnosed by the professional through the prior prescription of other complementary diagnostic tests. Clinical case A 40-year-old female patient came to the Oral Surgery Teaching unit of the university of Santiago de Compostela, referred by her dentist, who had previously treated her for bruxism and TMJ joint dysfunction with an anterior joint repositioning splint. The patient has been reporting for two years the existence of a progressive, bilateral and sometimes painful muscular bulging in the area of the masseter muscles. Although a clear differential diagnosis with other pathologies could be established by inspection and clinical history, we indicated conventional imaging tests, magnetic resonance imaging and ultrasound of both parotid spaces and the area of both masseter muscles.