Cochrane Summaries

Trusted evidence. Informed decisions. Better health.

Botulinum toxin type A for masseter hypertrophy

Fedorowicz Z, van Zuuren EJ, Schoones J
Published Online: 
9 September 2013

Masseter muscle hypertrophy occurs as a soft enlargement of the jaw muscles near the angle of the lower jaw and seldom presents a major health problem. However, in some individuals the swelling can be associated with pain or may be so large that it causes facial disfigurement. Although the cause of the condition is unclear it does appear to be more common in certain ethnic groups.

Symptoms such as pain can be treated with muscle relaxants and may also include bite adjustments or involve the use of splints on the teeth. Surgical reduction of the jaw muscle or injections of botulinum toxin type A directly into the muscle are other treatment options. Botulinum toxin type A is a powerful neurotoxin produced by the anaerobic organism Clostridium botulinum. When botulinum toxin type A is injected into a muscle it causes interference with the neurotransmitter mechanism producing selective loss of muscle function and a subsequent decrease in the mass of the muscle.

Although the use of botulinum toxin injections might appear to have certain advantages over surgery the authors of this review did not find any high quality studies that evaluated the effectiveness and potential side effects of botulinum toxin type A for the management of benign masseter hypertrophy. Well-designed randomised controlled trials are needed to assess the effectiveness and safety (i.e. side effects) of this intervention.

This record should be cited as: 
Fedorowicz Z, van Zuuren EJ, Schoones J. Botulinum toxin for masseter hypertrophy. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD007510. DOI: 10.1002/14651858.CD007510.pub3
Assessed as up to date: 
27 April 2013