PMC5907395_01
(a) Initial profile image; (b) profile image after one month of the first botulinum toxin application; (c) profile image after one month of the second botulinum toxin application; (d) profile image after six months of the surgery.
CRID2018-7168472.001.jpg
PMC5907395_01_CRID2018-7168472.001.jpg
fig1
A 22-year-old male patient applied to our clinic for painless asymmetric swelling on the right side of the face for five years (Figure 1(a)). Percutaneous intramuscular injection of botulinum toxin type A was performed to the hypertrophic muscle using 2 ml syringe with 25G needle. 75 units of botulinum toxin type A was injected equally into five points at the centre of the lower third of the masseter muscle (Figure 1(b)). A decrease in the size of the masseter muscle was seen after one month of the application (Figure 1(c)). The patient was followed for one year without any problems (Figure 1(d)).
(a) Initial panoramic view; (b) panaromic view after six months of the surgery.
CRID2018-7168472.002.jpg
PMC5907395_01_CRID2018-7168472.002.jpg
fig2
In CT and panoramic radiographs, reactive bone formation and significant asymmetry compared to the left side were observed in the mandibular angular region on the right side (Figure 2(a)).
(a) Intraoperative view of the resected fragments of the right and left angulus of the mandible and 2/3 inner belly of the right masseter muscle; (b) extraoral submandibular approach.
CRID2018-7168472.003.jpg
PMC5907395_01_CRID2018-7168472.003.jpg
fig3
Complete separation and removal of the segment from mandible were accomplished using a periosteum retractor (Figures 3(a) and 3(b)).
Pre-op (a) and post-op (b) MR views. Decreased volume of the right masseter muscle can be seen obviously.
CRID2018-7168472.004.jpg
PMC5907395_01_CRID2018-7168472.004.jpg
fig4
From MR views which were taken one year following the surgery, the decreased volume of the right masseter muscle can be seen apparently (Figures 4(a) and 4(b)).