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MASSETER MUSCLE SPASM WITH FACIAL ASYMMETRY TREATED BY STABILIZATION SPLINT

MASSETER MUSCLE SPASM WITH FACIAL ASYMMETRY TREATED BY STABILIZATION SPLINT

Purpose: Facial asymmetry may be caused by soft or hard tissue asymmetries. Chewing muscle spasms and/or hypertrophies may be responsible for facial asymmetry and also spasm of elevator muscles of lower jaw may change the mandibular position. The purpose of this case report is to reach the orthopedically stable position of the lower jaw by treating temporomandibular disorders (TMD) that may cause facial asymmetry with a stabilization splint and to reestablish the occlusion according to this stable position.

Case Report: A 33-year-old female patient attended to clinic with the complaint of increasing asymmetry on her face over time and unpleasant laminate veneers. In extra-oral examination it was observed that the chin tip was deviated to the right and there was swelling in the right masseter area. In the gnathological examination performed according to diagnostic criteria for temporomandibular disorders (DC/TMD), it was determined that the patient had swelling, stiffness and tenderness especially in the right masseter muscle and the pain score was 5 on palpation. Pain score of left masseter muscle was also found as 4. Disc displacement with reduction was diagnosed on right temporomandibular joint. Bruxism findings were found in the intra-oral examination such as facets in canines, abfractions and white fibrous line that appears on the inside of the cheek. In addition, laminate veneers on anterior teeth and laminate veneers covering the occlusal surface on posterior teeth were threatening the gingival health due to poor adaptation and they were aesthetically unacceptable. It was thought that the asymmetry on the face could be caused by the bone as well as the masseter muscle, and an additional panoramic radiography was requested from the patient. When the panoramic radiography was examined, the right mandibular ramus was shorter than the left mandibular ramus, but it was considered that masseter muscle spasm was also aggravated the asymmetry of the face. It was aimed to eliminate muscle spasm with stabilization splint treatment before renewing of the laminates and thus to reach orthopedically stable mandibular position as a priority. After this position was achieved, it was decided to re-evaluate the occlusion and re-establish the occlusion according to the obtained orthopedically stable position of the lower jaw with anterior and posterior occlusal covering laminates. Stabilization splint treatment for muscle spasm was applied for 4 months with monthly control sessions. It was observed that edema and spasm in the muscle eliminated and thus facial asymmetry decreased. On palpation, the pain score of the masseter muscles decreased to 1 on both sides. It was observed that the chin tip approached the midline in the resting vertical dimension. When the occlusion was checked after the splint treatment, it was seen that there was posterior disclusion on the right side but all the painful symptoms were eliminated so that the lower jaw reached orthopedically stable position. Occlusal stability was also achieved by reorganizing the occlusion according to this stable mandibular position. Since bruxism continued, a new protective stabilization splint was considered to protect the upper laminate veneers so that the treated TMD would not recur.

Conclusion: If TMD is diagnosed according to the gnathological examination, it is appropriate to treat the TMD and re-organize the occlusion according to the new orthopedically stable position of the lower jaw before the restorations are carried out. Thus, it is possible to reach an aesthetic and functional balance. Key words: masseter spasm, stabilization splint, facial asymmetry

Pınar Kursoğlu
Yeditepe University
Turkey

Elifnaz Özen
Yeditepe University
Turkey

Püren Barut
Yeditepe University
Turkey

 


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