Case Report Combination of Medical and Surgical Treatments for Masseter Hypertrophy M. Ayhan , Sabri Cemil ˙ Is ¸ler, and C. Kasapoglu Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Istanbul, Turkey Correspondence should be addressed to M. Ayhan; drmustafaayhan@gmail.com Received 8 November 2017; Revised 11 January 2018; Accepted 12 March 2018; Published 5 April 2018 Academic Editor: Maria Beatriz Duarte Gavião Copyright © 2018 M. Ayhan et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Masseter hypertrophy (MH) is one of the uncommon conditions that swelling can be seen in the angular mandibular region of the face. e etiology of MH includes several factors, and various treatment methods are mentioned in the literature. Botulinum toxin type A application is most commonly used for the treatment because of its less invasive feature. As a surgical method, some treatment alternatives that aim to reduce muscle mass or reshape the bone tissue in the angular region are considered. In this case report, a 21-year-old male patient with unilateral masseter hypertrophy on the right side is presented. After the patient was diagnosed with MH, botulinum toxin treatment in two sessions at one-month intervals was done. Since the reduction in muscle volume was not in satisfactory dimensions after the botulinum toxin application, the masseter was reduced on the right side through an intraoral approach. At the same time, bone enlargements on each side of the angulus mandibula were reshaped and smoothened through an extraoral retro mandibular approach. Clinical and radiographic evaluation of the patient revealed more aesthetic and symmetrical appearance in the regular controls. 1. Introduction Masseter hypertrophy (MH) is an uncommon condition that can cause aesthetic and functional problems. Aesthetic problems consist of prominent masseter muscle in the face, rectangular face shape, and wide mandibular angle. Patients may suffer psychological issues due to an unattractive look [1]. Differential diagnosis requires clinical history and physical examination and may even include complementary imagination resources such as magnetic resonance (MR) and computed tomography (CT) scans to exclude other disor- ders. Differential diagnosis must consist of muscle tumors, salivary gland disorders, and intrinsic masseter myopathy. In some cases, patients may report signs and symptoms of well-localized pain [1, 2]. However, it is asymptomatic, and patients’ chief complaint is about aesthetics. Moreover, masseteric musculature is inserted in the mandibular angle anatomically and can cause overdevelopment of these angles because of its traction forces [2]. e etiology of MH has been attributed to many factors such as tensions and clenching caused by emotional stress, chronic bruxism, masseteric hyperfunction, and parafunction. It is essential to make the differential diagnosis of head and neck mass, particularly unilateral mass located in the cheek. e possible underlying pathologic factors should be assessed carefully with detailed patient history and imaging techniques before deciding on treatment [3]. Treatment of MH is controversial. Varying degrees of success have been reported for some of the treatment options for MH which range from simple phar- macotherapy to more invasive surgery. Reduction of the masseter muscle, osteotomy, botulinum toxin, and splint therapy are options for managing this problem [2, 3]. In- jection of botulinum toxin type A into the masseter muscle is considered as a less invasive modality and has been reported to be successfully used for cosmetic sculpting of the lower face [4]. Botulinum toxin type A (botulinum toxin) is a potent neurotoxin which is produced by the anaerobic organism Clostridium botulinum and when injected into a muscle causes interference with the neurotransmitter mechanism, producing selective paralysis and subsequent atrophy of the muscle [3–5]. Results showed the efficiency of botulinum in MH, but many times in MH concomitant with bone en- largement in the angulus; therefore, the best aesthetic results may be gained with manipulation of the bony structure. e Hindawi Case Reports in Dentistry Volume 2018, Article ID 7168472, 5 pages https://doi.org/10.1155/2018/7168472