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Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
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Masseter muscle reattachment after mandibular angle surgery.

Mathew A Thomas1, Michael J Yaremchuk

  • 1Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.

Aesthetic Surgery Journal
|December 1, 2009
PubMed
Summary

Masseter muscle disinsertion is a complication of mandibular angle surgery. Repair involves reattaching the muscle to the mandible

Area of Science:

  • Plastic and reconstructive surgery
  • Oral and maxillofacial surgery
  • Aesthetic surgery

Background:

  • Altering mandibular angle dimensions via alloplastic augmentation or skeletal reduction necessitates elevating the masseter muscle's insertion, including the pterygomasseteric sling.
  • Disruption of the pterygomasseteric sling can lead to masseter muscle retraction, causing soft tissue volume loss and a skeletonized appearance at the mandibular angle.
  • Muscle contraction after disinsertion can worsen the deformity with increased skeletonization and a soft tissue bulge.

Purpose of the Study:

  • To describe masseter muscle disinsertion as a complication of mandibular angle surgery.
  • To review the technique for repairing this specific deformity.

Main Methods:

  • Review of records from 60 patients (44 primary, 16 secondary) who underwent alloplastic mandible augmentation between 2003 and 2008.

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  • Identification of patients exhibiting clinical signs of pterygomasseteric sling disruption.
  • Main Results:

    • Nine patients presented with signs of pterygomasseteric sling disruption post-mandibular angle surgery.
    • Five patients showed complete disruption, with two requesting reconstruction.
    • Four patients had partial disruption; successful reinsertion of the masseter was achieved using drill holes at the inferior mandibular border via a Risdon approach.

    Conclusions:

    • Masseter muscle disinsertion is an unreported complication following aesthetic surgery of the mandibular angle.
    • The resulting contour deformity, both static and dynamic, can be effectively corrected by reattaching the masseter muscle to the inferior border of the mandible.