Bilateral temporalis hypertrophy

Abstract

Temporalis muscle hypertrophy is rare and may present unilaterally or bilaterally. Variable combinations with masseteric hypertrophy are also reported. It may be associated with a parafunctional habit or occur as an idiopathic entity. A host of modalities including CT, MRI, ultrasonography and muscle biopsy may be utilized for diagnosis. While surgical reduction remains an option, medical therapy with boutlinum type A toxin is the treatment of choice. A case of bilateral temporalis hypertrophy in a 38-year-old female is reported.

Bilateral hypertrophy of temporalis muscle is a rare clinical entity and only a few cases are cited . Isolated cases of unilateral temporalis hypertrophy and variable combinations of temporalis and masseteric hypertrophy are also reported . Temporalis muscle hypertrophy is regarded as reactive in nature, but may be idiopathic . Traditionally, surgical reduction was the treatment of choice for correction of muscle hypertrophy in the maxillofacial region . Medical management utilizing botulinum toxin A, has become the treatment of choice and has been used successfully to correct temporalis and masseteric hypertrophy . A case of bilateral temporalis hypertrophy in a 38-year-old female is reported.

Case report

A 38-year-old female was referred with bilateral swelling in her temporal region. The patient had been aware of the swelling for many years and complained of recurrent headaches. Her medical history was unremarkable.

Clinical examination showed a marked swelling involving the temporalis muscle bilaterally ( Figs. 1 and 2 ). The muscle bulk was more prominent when the patient clenched her teeth. There was no evidence of bruxism. The masseter muscle bulk was within the normal range bilaterally. There were no other remarkable clinical findings. Her orthopantomogram did not reveal any abnormality. An MRI scan showed hypertrophy of the temporalis muscle bilaterally with no evidence of a neoplastic process and no evidence of masseter involvement. A diagnosis of bilateral temporalis muscle hypertrophy was made.

Fig. 1
Left temporalis hypertrophy, pre-treatment view.

Fig. 2
Right temporalis hypertrophy, pre-treatment view.

Treatment was carried out by percutaneous injection of 500 units of botulinum type A toxin ( Dysport ) into the temporalis muscle bilaterally. The response to botulinum injections was remarkable and complete resolution of muscle hypertrophy was observed within 4 weeks ( Figs. 3 and 4 ). The patient remains under the authors’ care.

Feb 8, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Bilateral temporalis hypertrophy
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