Introduction

Temporomandibular joint dysfunction (TMD) can be a debilitating source of pain in the jaw. The temporomandibular joint (TMJ) is the joint that connects the jaw to the skull. Dysfunction of the TMJ affects 5-12% of people. Pain in the jaw primarily causes headaches and difficulty chewing secondary to pain. In addition to TMD, the masseter muscle, which is the main muscle used for chewing can also be a pain generator. The masseter muscle can have chronic muscle pain just like many other muscle in your body. If you think about it, this muscle is used for chewing and talking all day. Injuries to the masseter can result in local trigger points, scar tissue formation or inflammation. At The Fascia Institute and Treatment Center, we focus on masseter muscle assessments with ultrasound and masseter hydrodissection treatments to allow the muscle to heal.

Hydrodissection

A masseter hydrodissection is a reasonable technique that can be used to treat TMD. At The Fascia Institute and Treatment Center we perform a physical exam to determine the cause(s) of your jaw pain. We then utilize ultrasound imaging to assess the tissue health of the masseter muscle. If there are abnormalities noted on ultrasound imagining, we will recommend a hydrodissection procedure to release scar tissue or fascia in the muscle. This procedure can both help with pain, and in many cases improve the alignment of the jaw. For example, if you have a tight masseter muscle that is pulling your jaw to one side or another, this procedure may help.

Case Report

A 42-year old woman with a history of Hashimoto’s disorder, asthma and sleep apnea reported jaw and neck pain. She has seen multiple dentists and reported some benefit from a night guard, but she still had significant pain. She was beginning to lose weight because chewing hurt. She had to frequently stretch her mouth open to reset the jaw, which mildly helped with pain relief. Botox helped some, but she felt like it made her chewing weaker. On exam, she was tender over the masseter muscle. The TMJ did click on occasion when opening her mouth. Because of significant tenderness over the masseter muscle, she decided to proceed with a hydrodissection of the masseter muscle. Following the hydrodissection, she reported 100% pain relief, although the jaw felt full. She reported mild soreness after the procedure for 36 hours. Following the time of soreness, she reported 100% pain relief and started eating normally again. She was no longer losing weight and happy that she went through with the procedure.

Summary

The masseter muscle is a significant and relevant cause of TMD and jaw pain. Masseter muscles can get injured just like any other muscle. If your clinical story and exam is consistent with pain in the masseter muscle you may consider an US evaluation at The Fascia Institute and Treatment Center. If abnormalities of the masseter muscle are confirmed, you may consider proceeding with a masseter fascial hydrodissection. In our experience, one injection has worked well in many cases; however, more than one treatment may be needed.

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