Case Report of Meckel Cave Mass and Unilateral Masseter Hypertrophy Managed with Serial Botox Injections

Abstract

We present a case report of a young girl who initially presented with asymmetric fullness of the left face and was found to have unilateral masseter hypertrophy at 9 years. An MRI was performed, revealing an ipsilateral mass within the Meckel cave, involving the trigeminal ganglion and tracking along V3 through the foramen ovale into the infratemporal fossa. At 14 years of age, an endoscopic biopsy was performed of V3 within the Meckel cave. The nerve was traced into the infratemporal fossa and was markedly enlarged. Multiple biopsies were taken of the neural tissue and surrounding fibrofatty tissues with no abnormalities found. By 15 years of age, she began to develop mild trismus and intermittent painful muscular spasms. She was initiated on serial Botox injections which have been continued since this time. Her spasm and facial asymmetry have improved substantially as has her trismus. The abnormal enlargement of the trigeminal nerve has been followed with repeated MRI and has demonstrated no further enlargement or changes.