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An 18-year-old girl sought medical advice for an asymptomatic prominence of the right malar region evolving for two years because of cosmetic concern. Her medical history was relevant for Salmonella infection during a trip in Africa. The patient did not consume alcohol or use illicit drugs. She reported no history of trauma, fever, blurred vision or headache. On examination she was healthy. A prominence of the left lateral jaw was observed with normal overlying skin, limited mobility, and not painful to palpation. (Fig. 1A). Enlargement of the left jaw and right temporalis region with no signs of inflammation was also found. Clinical examination was otherwise unremarkable. Routine blood examination including blood cell count and creatine phosphokinase level was normal, search for antinuclear antibody and myositis-specific autoantibodies was negative. Head Magnetic Resonance Imaging (MRI) revealed a homogenous hypertrophy of left and right masseters and right temporalis with no signs of myositis, and no intracranial or bone lesions were detected (Figs. 1B and C).
Fig. 1A: Asymmetric enlargement of right temporalis region and left jaw. B: Right temporalis muscle hypertrophy on a coronal MRI T1 image T1. C: left master muscle hypertrophy on a coronal MRI T2 image.
]. Indeed potential causes include local factors such as dental malocclusion, prognathism, temporomandibular joint disease and bruxism, but psychogenic factors may also play a role [
]. Diagnosis usually relies on the medical history, clinical examination, and non-invasive tests. However muscle biopsy can be useful in order to rule out non-reactive conditions such as myositis, trauma, neoplasm, lipomatosis and auto-immune disease [
]. Treatment of reactive masticatory muscle hypertrophy consists mainly of botulinum toxin injection in case of bruxism or surgical intervention for local factors [
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