Masseter Muscle Reattachment After Mandibular Angle Surgery
Accepted 26 February 2009.
Background
Altering the dimensions of the mandibular angle by alloplastic augmentation or skeletal reduction requires elevation of the insertion of the masseter muscle, including the pterygomasseteric sling. Disruption of the pterygomasseteric sling during exposure of the inferior border of the mandible can cause the masseter muscle to retract superiorly, resulting in a loss of soft tissue volume over the angle of the mandible and a skeletonized appearance. Subsequent contraction of the masseter elevates the disinserted edge of the muscle and not only increases the skeletonized area, but also exaggerates the deficiency by causing a soft tissue bulge above it.
Objective
The authors describe the disinsertion of the masseter and the resulting deformity as a potential complication of mandibular angle surgery and review the technique for repair.
Methods
The records of 60 patients (44 primary, 16 secondary) who presented for alloplastic mandible augmentation between 2003 and 2008 were reviewed.
Results
Nine patients presented with clinical signs of disruption of the pterygomasseteric sling after mandibular angle surgery. Five patients had clinical signs consistent with complete disruption. Two of these patients requested reconstruction. The other four had signs consistent with partial disruption. Through a Risdon approach, the masseter was successfully reinserted using drill holes placed at the inferior border of the mandible.
Conclusions
Masseter disinsertion is a previously unreported sequelae after aesthetic surgery for the angle of the mandible. The resultant static and dynamic contour deformity can be corrected by reattaching the muscle to the inferior border of the mandible.
Reprint requests: Michael J. Yaremchuk, MD, Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, 15 Parkman St., Wang 435, Boston, MA 02114
DISCLOSURES
The authors have no disclosures with respect to the contents of this article.
1 Dr. Thomas is a resident in plastic surgery and Dr. Yaremchuk is the Director of Craniofacial Surgery in the Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
ABSTRACT