PARODOXICAL BULGING PHENOMENA AFTER MASSETER BOTOX INJECTIONS; CASE SERIES AND THE REVIEW OF THE LITERATURE

Abstract

Aim: The temporomandibular joint (TMJ), also known as the mandibular joint; is a nearby the synovial joint that connects the mandible to the temporal bone the external auditory canal. Although TMJ disorders are frequently seen; they can be caused by many reasons such as disorders caused by masticatory muscles, condyle and articular disc incompatibility, inflammatory joint diseases, chronic mandibular hypomobility, and congenital or acquired muscle and bone disorders.
 Case reports: In our study, the diagnosis and treatment process of 4 patients who applied to the Gazi University Faculty of Dentistry Department of Oral and Maxillofacial Surgery clinic with complaints of TMJ pain were presented. All of the cases had masseter hypertrophy due to bruxism. Botulinum toxin-A (BTA) was injected to the masseter muscles bilateraly after written informed consents were obtained from each patients before the procedure. In the control examinations an unexpected paradoxical masseteric bulging was detected. A more superficial BTA injection was applied to the superficial lobe of the masseter muscles that was not affected by BTA in presented patients and the complaints were dissolved in ten days.
 Conclusions: The cases presented in our article have a rare complication of BTA injections and can be treated easily after a correct diagnosis by the physician. Physicians who perform BTA injections for bruxism and masseter hypertrophy should be aware of the possible complications and should have sufficient knowledge and experience to overcome it.