Skip to main content Skip to main navigation menu Skip to site footer
  • Register
  • Login
  • Menu
  • Home
  • Current
  • Archives
  • Announcements
  • About
    • About the Journal
    • Submissions
    • Editorial Team
    • Privacy Statement
    • Contact
  • Register
  • Login

Quality in Sport

Adverse effects of treating bruxism and masseter muscle hypertrophy with botulinum toxin injection - a literature review
  • Home
  • /
  • Adverse effects of treating bruxism and masseter muscle hypertrophy with botulinum toxin injection - a literature review
  1. Home /
  2. Archives /
  3. Vol. 21 (2024) /
  4. Medical Sciences

Adverse effects of treating bruxism and masseter muscle hypertrophy with botulinum toxin injection - a literature review

Authors

  • Klaudia Ratyna Infant Jesus Clinical Hospital UCC MUW, Lindleya 4, 02-005 Warsaw, Poland https://orcid.org/0009-0005-2235-1105
  • Oliwia Bochenek Grochowski Hospital, Grenadierów 51/59, 04-073 Warsaw, Poland https://orcid.org/0009-0005-1482-2544
  • Mateusz Koper National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137, 02-507 Warsaw, Poland https://orcid.org/0000-0002-1048-2774
  • Jessica Kałuża University Clinical Centre of the Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland https://orcid.org/0009-0002-5050-2538
  • Adrian Konaszczuk Standalone Public Health Care Facility in Świdnik ul. Leśmiana 4, 21-040 Świdnik, Poland https://orcid.org/0009-0006-5775-5035
  • Aleksandra Nowak Infant Jesus Clinical Hospital UCC MUW, Lindleya 4, 02-005 Warsaw, Poland https://orcid.org/0009-0009-6602-4017
  • Oliwia Kozyra Prague hospital dedicated to the Transfiguration of the Lord Sp. z o. o., Aleja Solidarności 67, 03-401 Warsaw, Poland https://orcid.org/0009-0004-4882-3126
  • Zofia Szypuła Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0007-1671-5587
  • Katarzyna Paluch Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0004-2190-855X
  • Małgorzata Skarbek Provincial Hospital Center of the Jelenia Gora Valley, Oginskiego 6, 58-506 Jelenia Gora https://orcid.org/0000-0001-6227-4283

DOI:

https://doi.org/10.12775/QS.2024.21.54012

Keywords

Botulinum toxin, masseter hypertrophy, bruxism, adverse effects

Abstract

Background Botulinum toxin injection in the masseter muscle has gained popularity for both therapeutic and aesthetic applications, such as treating bruxism, masseter hypertrophy and lower facial slimming. Despite its efficacy, adverse effects associated with this procedure have been documented. This literature review aims to analyse and summarize the adverse effects associated with botulinum toxin injection in the masseter muscle, examining their incidence, underlying mechanisms and management strategies.

Keywords botulinum toxin, masseter hypertrophy, bruxism, complications, adverse effects

Material and methods A comprehensive search of databases including PubMed, MEDLINE and Google Scholar was conducted using above-mentioned keywords. 

Conclusions Masseter muscle botox injection is considered a safe procedure with low incidence rate. Although the complications are temporary, they can significantly reduce patient satisfaction and confidence. To minimize the risk of complications, clinicians should familiarize themselves with risk mitigation strategies.

References

Beddis, H., Pemberton, M., & Davies, S. (2018). Sleep bruxism: an overview for clinicians. BDJ. doi:10.1038/sj.bdj.2018.757

Lee, D. H., Jin, S.-P., Cho, S., Feneran, A., Youn, C. S., Won, C. H., … Lee, M. W. (2013). RimabotulinumtoxinB versus OnabotulinumtoxinA in the Treatment of Masseter Hypertrophy: A 24-Week Double-Blind Randomized Split-Face Study. Dermatology, 226(3), 227–232. doi:10.1159/000349984

Tuba Develi, Tansu Uzel, Emre Cesur, Sina Uçkan (2022) Long-term effects of botulinum toxin A injection on pain and quality of life in patients with myofascial pain of masticatory muscles: a retrospective study https://doi.org/10.5114/jos.2022.114218

Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxintype A. Neurotoxicology 2005;26:785–93

Peng, H.-L. P., & Peng, J.-H. (2017). Complications of botulinum toxin injection for masseter hypertrophy: Incidence rate from 2036 treatments and summary of causes and preventions. Journal of Cosmetic Dermatology, 17(1), 33–38. doi:10.1111/jocd.12473

Yeh, Y.-T., Peng, J.-H., & Peng, H.-L. P. (2018). Literature review of the adverse events associated with botulinum toxin injection for the masseter muscle hypertrophy. Journal of Cosmetic Dermatology. doi:10.1111/jocd.12721

Choe SW, Cho WI, Lee CK, Seo SJ. Effects of botulinum toxin type A on contouring of the lower face. Dermatol Surg. 2005;31(5):502‐ 508.

Kim JH, Shin JH, Kim ST, Kim CY. Effects of two different units of botulinum toxin type a evaluated by computed tomography and electromyographic measurements of human masseter muscle. Plast Reconstr Surg. 2007;119(2):711‐717.

Shafei, S., Raafat, S., & Amin, A. (2022). Botilinium toxin injection, a potentially effective method for preventing implant failure in patients with bruxism. Egyptian Dental Journal, 68(3), 2561-2570. https://doi.org/10.21608/edj.2022.130816.2052

Persaud, R., Garas, G., Silva, S., Stamatoglou, C., Chatrath, P., & Patel, K. (2013). An evidence-based review of botulinum toxin (botox) applications in non-cosmetic head and neck conditions. JRSM Short Reports, 4(2), 1-9. https://doi.org/10.1177/2042533312472115

Hwang, K. (2014). Discussion on the risorius muscle. Dermatologic Surgery, 40(12), 1340-1341. https://doi.org/10.1097/dss.0000000000000144

Rathod, N. and John, R. (2023). Botulinum toxin injection for masseteric hypertrophy using 6 point injection technique – a case report. proposal of a clinical technique to quantify prognosis. Clinical Cosmetic and Investigational Dentistry, Volume 15, 45-49. https://doi.org/10.2147/ccide.s396057

Liew S, Dart A. Nonsurgical reshaping of the lower face. Aesthet Surg J. 2008;28(3):251–257.

Wei J, Dong J, Li Q, Dai C. Prolonging the duration of masseter muscle reduction by adjusting the masticatory movements after the treatment of masseter muscle hypertrophy with botulinum toxin type A injection. Dermatol Surg. 2015;41(Suppl 1):S101–S109.

Ahn, J., Horn, C., & Blitzer, A. (2004). Botulinum toxin for masseter reduction in asian patients. Archives of Facial Plastic Surgery, 6(3), 188-191. https://doi.org/10.1001/archfaci.6.3.188

Yu, X., Diao, X., Dong, D., Xu, W., Liu, T., Zhou, Y. & Chen, Y. (2022). Effects of two botulinum toxin type a evaluated by shear wave elastography and electromyographic measurements of masseter reduction. Journal of Craniofacial Surgery, 33(5), 1450-1453. https://doi.org/10.1097/scs.0000000000008368

Wu W. Botox facial slimming/facial sculpting: the role of botulinum Toxin‐A in the treatment of hypertrophic masseteric muscle and parotid enlargement to narrow the lower facial width. Facial Plast Surg Clin North Am. 2010;18(1):133‐140.

Kim NH, Chung JH, Park RH, Park JB. The use of botulinum toxin type A in aesthetic mandibular contouring. Plast Reconstr Surg. 2005;115(3):919–930.

Lee SJ, Kang JM, Kim YK, Park J, Kim DY. Paradoxical bulging of muscle after injection of botulinum neurotoxin type A into hypertrophied masseter muscle. J Dermatol. 2012;39:804-805.

Lee HJ, Kang IW, Seo KK, et al. The anatomical basis of paradoxical masseteric bulging after botulinum neurotoxin type A injection. Toxins (Basel). 2017;9:14.

Lee SK. Antibody‐induced failure of botulinum toxin type A therapy in a patient with masseteric hypertrophy. Dermatol Surg. 2007;33(1 Spec No.):S105–S110.

Fabi, S., Park, J., Ho, W., Vachiramon, V., & Dayan, S. (2023). Aesthetic considerations for treating the asian patient: thriving in diversity international roundtable series. Journal of Cosmetic Dermatology, 22(6), 1805-1813. https://doi.org/10.1111/jocd.15787

Rewari, A., Dabas, N., Sanan, R., Phogat, S., Phukela, S., & Vigarniya, M. (2020). Esthetic rehabilitation using magnet-retained cheek plumper prosthesis. Case Reports in Dentistry, 2020, 1-4. https://doi.org/10.1155/2020/2769873

Wu, Y. and Wu, S. (2023). Botulinum toxin type a for the treatment of masseter muscle prominence in asian populations. Aesthetic Surgery Journal Open Forum, 5. https://doi.org/10.1093/asjof/ojad005

Yu, P., Zhai, H., Li, Z., Dong, R., Wu, T., Li, L., … & Yu, N. (2021). Pivotal role of injection volume on sunken cheek prevention in masseter muscle bont‐a injection: a cadaver study. Journal of Cosmetic Dermatology, 21(1), 137-141. https://doi.org/10.1111/jocd.14658

Brown, A. and Teller, C. (2022). Identifying and managing complications caused by cosmetic neurotoxin treatment. Dermatological Reviews, 3(4), 247-256. https://doi.org/10.1002/der2.149

Gur, E., Stahl, S., Barnea, Y., Leshem, D., Zaretski, A., Amir, A., … & Arad, E. (2009). Comprehensive approach in surgical reconstruction of facial nerve paralysis: a 10-year perspective. Journal of Reconstructive Microsurgery, 26(03), 171-180. https://doi.org/10.1055/s-0029-1242139

Hwang K. Discussion on the risorius muscle: anatomic considerations with reference to botulinum neurotoxin injection for masseteric hypertrophy. Dermatol Surg. 2014;40(12):1340–1341.

Yi KH, Lee HJ, Hur HW, Seo KK, Kim HJ. Guidelines for botulinum neurotoxin injection for facial contouring. Plast Reconstr Surg 2022;150:562e-71e.

Ferreira-Pileggi, B., Freire, A., Botacin, P., Prado, F., & Rossi, A. (2022). A different pattern of arrangement of the risorius muscle fibers: a case report. Cureus. https://doi.org/10.7759/cureus.22922

Bae JH, Choi DY, Lee JG. The risorius muscle: anatomic considerations with reference to botulinum neurotoxin injection for masseteric hypertrophy. Dermatol Surg. 2014;40(12):1334–1339.

Mehta, V. (2023). A review on bigonial width reduction by botulinum toxin injections in masseter. Bioinformation, 19(3), 272-277. https://doi.org/10.6026/97320630019272

Hsu TS, Dover JS, Arndt KA. Effect of volume and concentration on the diffusion of botulinum exotoxin A. Arch Dermatol 2004;140: 1351Y1354

Kim, D.-H., Hong, H.-S., Won, S.-Y., Kim, H.-J., Hu, K.-S., Choi, J.-H., & Kim, H.-J. (2010). Intramuscular Nerve Distribution of the Masseter Muscle as a Basis for Botulinum Toxin Injection. Journal of Craniofacial Surgery, 21(2), 588–591. doi:10.1097/scs.0b013e3181d08bb3

Shehri, Z., Alkhouri, I., Hajeer, M., Haddad, I., & Hawa, M. (2022). Evaluation of the efficacy of low-dose botulinum toxin injection into the masseter muscle for the treatment of nocturnal bruxism: a randomized controlled clinical trial. Cureus. https://doi.org/10.7759/cureus.32180

Tomeva, N., Deliverska, E., & Ignatov, P. (2022). The therapeutic use of botulinum toxin in different oral and maxillofacial conditions. Journal of Medical and Dental Practice, 9(2), 1491-1497. https://doi.org/10.18044/medinform.202292.1491

Dimberg U, Petterson M. Facial reactions to happy and angry facial expressions: evidence for right hemisphere dominance. Psychophysiology. 2000 Sep;37(5):693-6. PMID: 11037045.

Thomas RJ, Whittaker J, Pollock J. Discerning a smile - The intricacies of analysis of post-neck dissection asymmetry. Am J Otolaryngol. 2022 Jan-Feb;43(1):103271. doi: 10.1016/j.amjoto.2021.103271.

Yoshitatsu S, Shiraishi M, Arika T. A fascia bow traction method for the treatment of unilateral marginal mandibular nerve paralysis after mandibulectomy for head and neck cancer. JPRAS Open. 2022 Jul 30;34:51-59. doi: 10.1016/j.jpra.2022.07.004.

Witmanowski H, Błochowiak K. The whole truth about botulinum toxin - a review. Postepy Dermatol Alergol. 2020 Dec;37(6):853-861. doi: 10.5114/ada.2019.82795.

Wu WTL. Botox facial slimming/facial sculpting: the role of botulinum toxin-a in the treatment of hypertrophic masseteric muscle and parotid enlargement to narrow the lower facial width. Facial Plast Surg Clin North Am. 2010;18:133-140.

Baş B, Ozan B, Muğlali M, Celebi N. Treatment of masseteric hypertrophy with botulinum toxin: a report of two cases. Med Oral Patol Oral Cir Bucal. 2010;15(4):e649–e652.

​​43.Dutra, E., Brien, M., Lima, A., Kalajzić, Ž., Tadinada, A., Nanda, R., … & Yadav, S. (2016). Cellular and matrix response of the mandibular condylar cartilage to botulinum toxin. Plos One, 11(10), e0164599. https://doi.org/10.1371/journal.pone.0164599

Kim, D., Jang, H., Park, K., & Huh, J. (2019). Effect of bisphosphonate on temporomandibular joint in osteopenia-induced rats by botulinum toxin injection on masticatory muscle: a preliminary study. Maxillofacial Plastic and Reconstructive Surgery, 41(1). https://doi.org/10.1186/s40902-019-0193-5

Lee, H.-J., Kim, S.-J., Lee, K.-J., Yu, H.-S., & Baik, H.-S. (2017). Repeated injections of botulinum toxin into the masseter muscle induce bony changes in human adults: A longitudinal study. The Korean Journal of Orthodontics, 47(4), 222. doi:10.4041/kjod.2017.47.4.222

Lee, H., Choi, Y., Lee, K., Kim, S., & Kim, H. (2019). Ultrasonography of the internal architecture of the superficial part of the masseter muscle in vivo. Clinical Anatomy, 32(3), 446-452. https://doi.org/10.1002/ca.23337

Bae H, Kim J, Seo KK, Hu KS, Kim ST, Kim HJ. Comparison between Conventional Blind Injections and Ultrasound-Guided Injections of Botulinum Toxin Type A into the Masseter: A Clinical Trial. Toxins (Basel). 2020 Sep 11;12(9):588. doi: 10.3390/toxins12090588.

Kobal F, Baqer A, Shanthini Singaram J. Botulinum Toxin A for Spastic Trismus Due to Brain Stem Encephalitis in a Pediatric Intensive Care Setting: A Unique Case Report. J Pediatr Intensive Care. 2018 Dec;7(4):216-218. doi:10.1055/s-0038-1660507.

Alwayli, H. (2016). Treatment of chronic pain associated with nocturnal bruxism with botulinum toxin. a prospective and randomized clinical study. Journal of Clinical and Experimental Dentistry, 0-0. https://doi.org/10.4317/jced.53084

Quezada-Gaon, N., Wortsman, X., Peñaloza, O., & Carrasco, J. (2016). Comparison of clinical marking and ultrasound‐guided injection of botulinum type a toxin into the masseter muscles for treating bruxism and its cosmetic effects. Journal of Cosmetic Dermatology, 15(3), 238-244. https://doi.org/10.1111/jocd.12208

Koo, H. (2023). Do repetitive botulinum neurotoxin injections induce muscle fibrosis? sonographic observation of the masseter muscle. Journal of Cosmetic Dermatology, 23(2), 434-440. https://doi.org/10.1111/jocd.16022

Li, Z., Li, Z., Li, Y., Dong, R., Chen, C., Huang, J., … & Yu, N. (2022). Ultrasonographic observation of the masseter muscle after injection of different botulinum toxin type a. Journal of Cosmetic Dermatology, 21(11), 5555-5561. https://doi.org/10.1111/jocd.15106

Camgoz, M., Erdil, D., Bağiş, N., Eren, H., & Orhan, K. (2023). The evaluation of the relationship between changes in masseter muscle thickness and tooth clenching habits of bruxism patients treated with botulinum toxin a. Journal of Medical Ultrasound, 31(1), 22. https://doi.org/10.4103/jmu.jmu_51_22

Kalman, L., Piva, A., Queiroz, T., & Tribst, J. (2021). Biomechanical behavior evaluation of a novel hybrid occlusal splint-mouthguard for contact sports: 3D-FEA. https://doi.org/10.20944/preprints202110.0277.v1

Parte, A., Monticelli, F., Toro-Román, V., & Fuente, F. (2021). Differences in oral health status in elite athletes according to sport modalities. Sustainability, 13(13), 7282. https://doi.org/10.3390/su13137282

Queiroz, R., Castro, R., Caponi, L., Gosalvez, M., Calvo, J., Drago, S., … & Fernández, M. (2021). Oral health conditions and self-reported presence of pain in rowers: an epidemiology study. Revista Brasileira De Medicina Do Esporte, 27(6), 549-552. https://doi.org/10.1590/1517-8692202127062021_0131

Miranda, J., Santos, J., Aquino, J., Bonato, L., Carvalho, R., Filho, G., … & Tesch, R. (2022). Risks of resistance training for the bruxism: a cross-sectional study. Revista Eletrônica Acervo Saúde, 15(9), e10882. https://doi.org/10.25248/reas.e10882.2022

Freiwald, H., Schwarzbach, N., & Wolowski, A. (2020). Effects of competitive sports on temporomandibular dysfunction: a literature review. Clinical Oral Investigations, 25(1), 55-65. https://doi.org/10.1007/s00784-020-03742-2

Queiroz, T. (2023). Ergonomic sports mouthguards: a narrative literature review and future perspectives. Applied Sciences, 13(20), 11353. https://doi.org/10.3390/app132011353

Bonotto, D., Namba, E., Veiga, D., Wandembruck, F., Mussi, F., Cunali, P., … & Azevedo‐Alanis, L. (2015). Professional karate‐do and mixed martial arts fighters present with a high prevalence of temporomandibular disorders. Dental Traumatology, 32(4), 281-285. https://doi.org/10.1111/edt.12238

Vinereanu, A., Munteanu, A., Stănculescu, A., Farcașiu, A., & Didilescu, A. (2022). Ecological study on the oral health of romanian intellectually challenged athletes. Healthcare, 10(1), 140. https://doi.org/10.3390/healthcare10010140

Pinho, R., Campos, V., Pereira, C., & Farias, F. (2023). Brazilian special olympics athletes: oral health problems. Special Care in Dentistry, 44(1), 166-174. https://doi.org/10.1111/scd.12836

Khan, K., Qadir, A., Trakman, G., Aziz, T., Khattak, M., Nabi, G., … & Shahzad, M. (2022). Sports and energy drink consumption, oral health problems and performance impact among elite athletes. Nutrients, 14(23), 5089. https://doi.org/10.3390/nu14235089

Gaofeng L, Jun T, Bo P, et al. Evaluation and selecting indications for the treatment of improving facial morphology by masseteric injection of botulinum toxin type A. J Plast Reconstr Aesthet Surg. 2010;63(12):2026–2031.

Klein FH, Brenner FM, Sato MS, et al. Lower facial remodeling with botulinum toxin type A for the treatment of masseter hypertrophy. An Bras Dermatol. 2014;89(6):878–884.

Downloads

  • PDF

Published

2024-08-24

How to Cite

1.
RATYNA, Klaudia, BOCHENEK, Oliwia, KOPER, Mateusz, KAŁUŻA, Jessica, KONASZCZUK, Adrian, NOWAK, Aleksandra, KOZYRA, Oliwia, SZYPUŁA, Zofia, PALUCH, Katarzyna and SKARBEK, Małgorzata. Adverse effects of treating bruxism and masseter muscle hypertrophy with botulinum toxin injection - a literature review. Quality in Sport. Online. 24 August 2024. Vol. 21, p. 54012. [Accessed 26 December 2025]. DOI 10.12775/QS.2024.21.54012.
  • ISO 690
  • ACM
  • ACS
  • APA
  • ABNT
  • Chicago
  • Harvard
  • IEEE
  • MLA
  • Turabian
  • Vancouver
Download Citation
  • Endnote/Zotero/Mendeley (RIS)
  • BibTeX

Issue

Vol. 21 (2024)

Section

Medical Sciences

License

Copyright (c) 2024 Klaudia Ratyna, Oliwia Bochenek, Mateusz Koper, Jessica Kałuża, Adrian Konaszczuk, Aleksandra Nowak, Oliwia Kozyra, Zofia Szypuła, Katarzyna Paluch, Małgorzata Skarbek

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Stats

Number of views and downloads: 3302
Number of citations: 0

Search

Search

Browse

  • Browse Author Index
  • Issue archive

User

User

Current Issue

  • Atom logo
  • RSS2 logo
  • RSS1 logo

Information

  • For Readers
  • For Authors
  • For Librarians

Newsletter

Subscribe Unsubscribe

Tags

Search using one of provided tags:

Botulinum toxin, masseter hypertrophy, bruxism, adverse effects
Up

Akademicka Platforma Czasopism

Najlepsze czasopisma naukowe i akademickie w jednym miejscu

apcz.umk.pl

Partners

  • Akademia Ignatianum w Krakowie
  • Akademickie Towarzystwo Andragogiczne
  • Fundacja Copernicus na rzecz Rozwoju Badań Naukowych
  • Instytut Historii im. Tadeusza Manteuffla Polskiej Akademii Nauk
  • Instytut Kultur Śródziemnomorskich i Orientalnych PAN
  • Instytut Tomistyczny
  • Karmelitański Instytut Duchowości w Krakowie
  • Ministerstwo Kultury i Dziedzictwa Narodowego
  • Państwowa Akademia Nauk Stosowanych w Krośnie
  • Państwowa Akademia Nauk Stosowanych we Włocławku
  • Państwowa Wyższa Szkoła Zawodowa im. Stanisława Pigonia w Krośnie
  • Polska Fundacja Przemysłu Kosmicznego
  • Polskie Towarzystwo Ekonomiczne
  • Polskie Towarzystwo Ludoznawcze
  • Towarzystwo Miłośników Torunia
  • Towarzystwo Naukowe w Toruniu
  • Uniwersytet im. Adama Mickiewicza w Poznaniu
  • Uniwersytet Komisji Edukacji Narodowej w Krakowie
  • Uniwersytet Mikołaja Kopernika
  • Uniwersytet w Białymstoku
  • Uniwersytet Warszawski
  • Wojewódzka Biblioteka Publiczna - Książnica Kopernikańska
  • Wyższe Seminarium Duchowne w Pelplinie / Wydawnictwo Diecezjalne „Bernardinum" w Pelplinie

© 2021- Nicolaus Copernicus University Accessibility statement Shop