title: Bilateral hypertrophy of masseteric and temporalis muscles, our fifteen patients and review of literature.
abstract: OBJECTIVE
  The association of bilateral hypertrophy of temporalis and masseteric muscles is a rare clinical entity. The origin of the condition is unclear, causing cosmetic problems, pain, and functional impairment.
  
  
  METHODS
  In this paper we analyzed 15 patients treated at the Department of Maxillo-Facial Surgery of the University of Naples Federico II, from 2000 to 2013, for temporalis and/or masseteric muscle hypertrophy, and in particular, a rare case of a patient with a marked bilateral swelling of the temporalis and masseteric region, in conjunction with a review of the literature.
  
  
  RESULTS
  Fourteen patients have not any kind of postoperatively problems. The last patient had been aware of the swelling for many years and complained of recurrent headaches. We adopted a new protocol fort this patients and the patient was very pleased with the treatment results, and reported a reduction in headaches and a continuation of his well-being, in addition to greater self-confidence. The last follow-up was performed three years after the first treatment, and the patient showed a complete resolution of his symptoms, and just a small increase of the swelling.
  
  
  CONCLUSIONS
  The treatment of temporalis and masseteric hypertrophy with Botulin toxin could be an effective option compared to conservative treatment or surgical intervention, although the review of the literature shows that this is only a temporary treatment. In fact, surgery still remains the best option. The treatment must be repeated every 4/6 months for 2-3 consecutive years before having stable benefits. To overcome this problem, an association with a bite treatment allowed us to achieve more lasting and more stable results over time without a recurrence of symptoms between the treatments. Furthermore, this association has enabled us to obtain a more rapid reduction of the hypertrophy.
authors.affiliation: Maxillo-Facial Surgery Department, University Federico II, Naples, Italy. dottgraziano@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Graziano
authors.forename: G
authors.initials: G
authors.lastname: Dell'Aversana Orabona
authors.forename: F
authors.initials: F
authors.lastname: Astarita
authors.forename: L M
authors.initials: LM
authors.lastname: Ponzo
authors.forename: R
authors.initials: R
authors.lastname: Nunziata
authors.forename: G
authors.initials: G
authors.lastname: Salzano
authors.forename: F
authors.initials: F
authors.lastname: Maglitto
authors.forename: D
authors.initials: D
authors.lastname: Solari
authors.forename: A
authors.initials: A
authors.lastname: Santella
authors.forename: M
authors.initials: M
authors.lastname: Cappabianca
authors.forename: G
authors.initials: G
authors.lastname: Iaconetta
authors.forename: L
authors.initials: L
authors.lastname: Califano
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000473:pathology* / Q000628:therapy*; D007273:Injections, Intramuscular; D008297:Male; D008406:Masseter Muscle / Q000002:abnormalities* / Q000473:pathology*; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D013703:Temporal Muscle / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A