Masticatory Efficiency After Botulinum Toxin Injection in the Masseter Muscl
Mastication After Botulinum Toxin Injection in the Masseter Muscle
Keywords:
botulinum toxin, masseter muscle, masticatory function, chewing function questionnairesAbstract
Botulinum toxin (BoNT) injections into the masseter muscle are a popular, minimally invasive approach for lower face contouring. While altered masticatory function and chewing difficulties have been reported. This quasi-experimental clinical study aimed to investigate changes in masticatory function following BoNT type A injection into the masseter muscle. Twenty-four participants received injections of 50 units of botulinum toxin into the masseter muscles bilaterally and had their chewing performance assessed using a food chewing questionnaire completed online before injection and at 4, 8 and 12 week post-injection. Results showed no significant changes in masticatory performance throughout the 12-week study period. Median scores (out of 30) were 27.50 (baseline), 30.00 (4 weeks), 27.00 (8 weeks), and 24.00 (12 weeks), with no differences. This study suggests that BoNT-A injection into the masseter muscle does not significantly impair subjective masticatory function by a self-assessment questionnaire.
References
Gart MS, Gutowski KA. Overview of botulinum toxins for aesthetic uses. Clin Plast Surg 2016;43(3):459-71. doi: 10.1016/j.cps.2016.03.003
Jabbari B. History of botulinum toxin treatment in movement disorders. Tremor Other Hyperkinet Mov (N Y) 2016;6:394. doi: 10.7916/D81836S1
Pirazzini M, Rossetto O, Eleopra R, Montecucco C. Botulinum neurotoxins: Biology, pharmacology, and toxicology. Pharmacol Rev 2017;69(2):200-35. doi: 10.1124/pr.116.012658
Kundu N, Kothari R, Shah N, Sandhu S, Tripathy DM, Galadari H, et al. Efficacy of botulinum toxin in masseter muscle hypertrophy for lower face contouring. J Cosmet Dermatol 2022;21(5):1849-56. doi: 10.1111/jocd.14858
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):919-30. doi: 10.1097/01.prs.0000153236.79775.a0
Wu Y, Zeng D, Wu S. Botulinum toxin type A for the treatment of masseter muscle prominence in Asian populations. Aesthet Surg J Open Forum 2023;5:ojad005. doi: 10.1093/asjof/ojad005
van der Bilt A, Engelen L, Pereira LJ, van der Glas HW, Abbink JH. Oral physiology and mastication. Physiol Behav 2006;89(1):22-7. doi: 10.1016/j.physbeh.2006.01.025
Gonçalves TMSV, Schimmel M, van der Bilt A, Chen J, van der Glas HW, Kohyama K, et al. Consensus on the terminologies and methodologies for masticatory assessment. J Oral Rehabil 2021;48(6):745-61. doi: 10.1111/joor.13161
Fan Y, Shu X, Leung KCM, Lo ECM. Patient-reported outcome measures for masticatory function in adults: A systematic review. BMC Oral Health 2021;21(1):603. doi: 10.1186/s12903-021-01949-7
Peršić S, Palac A, Bunjevac T, Celebić A. Development of a new chewing function questionnaire for assessment of a self-perceived chewing function. Community Dent Oral Epidemiol 2013;41(6):565-73. doi: 10.1111/cdoe.12048
Wongcharee K, Prunkgnamphan C, Chaichit R, Paphangkorakit J. Subjective and objective masticatory function and their associated factors in complete denture wearers. M Dent J [internet]. 2024 Mar 26 [cited 2025 Jul 17];44(1):1-11. Available from: https://he02.tci-thaijo.org/index.php/mdentjournal/article/view/267362
Sunil Dutt C, Ramnani P, Thakur D, Pandit M. Botulinum toxin in the treatment of muscle specific Oro-facial pain: A literature review. J Maxillofac Oral Surg 2015;14(2):171-5. doi: 10.1007/s12663-014-0641-9
Zhang LD, Liu Q, Zou DR, Yu LF. Occlusal force characteristics of masseteric muscles after intramuscular injection of botulinum toxin A(BTX-A) for treatment of temporomandibular disorder. Br J Oral Maxillofac Surg 2016;54(7):736-40. doi: 10.1016/j.bjoms.2016.04.008
Peng HP, Peng JH. Complications of botulinum toxin injection for masseter hypertrophy: Incidence rate from 2036 treatments and summary of causes and preventions. J Cosmet Dermatol 2018;17(1):33-8. doi: 10.1111/jocd.12473
Park HU, Kim BI, Kang SM, Kim ST, Choi JH, Ahn HJ. Changes in masticatory function after injection of botulinum toxin type A to masticatory muscles. J Oral Rehabil 2013;40(12):916-22. doi: 10.1111/joor.12111
Majid OW. Clinical use of botulinum toxins in oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2010;39(3):197-207. doi: 10.1016/j.ijom.2009.10.022
Kwon KH, Shin KS, Yeon SH, Kwon DG. Application of botulinum toxin in maxillofacial field: Part I. Bruxism and square jaw. Maxillofac Plast Reconstr Surg 2019;41(1):38. doi: 10.1186/s40902-019-0218-0
Ahn KY, Kim ST. The change of maximum bite force after botulinum toxin type a injection for treating masseteric hypertrophy. Plast Reconstr Surg 2007;120(6):1662-6. doi: 10.1097/01.prs.0000282309.94147.22
Sari KI, Rafisa A. Chewing and swallowing patterns for different food textures in healthy subjects. Int J Dent 2023;2023:6709350. doi: 10.1155/2023/6709350
de Souza Nobre BB, Rezende L, Barbosa Câmara-Souza M, Sanchez-Ayala A, Blass R, Carbone AC, et al. Exploring botulinum toxin's impact on masseter hypertrophy: A randomized, triple-blinded clinical trial. Sci Rep 2024;14(1):14522. doi: 10.1038/s41598-024-65395-5
Pedroni-Pereira A, Marquezin MCS, Araujo DS, Pereira LJ, Bommarito S, Castelo PM. Lack of agreement between objective and subjective measures in the evaluation of masticatory function: A preliminary study. Physiol Behav 2018;184:220-5. doi: 10.1016/j.physbeh.2017.12.001
Fan Y, Shu X, Leung KCM, Lo ECM. Association between masticatory performance and oral conditions in adults: A systematic review and meta-analysis. J Dent 2023;129:104395. doi: 10.1016/j.jdent.2022.104395
Kim KS, Byun YS, Kim YJ, Kim ST. Muscle weakness after repeated injection of botulinum toxin type A evaluated according to bite force measurement of human masseter muscle. Dermatol Surg 2009;35(12):1902-7. doi: 10.1111/j.1524-4725.2009.01319.x
Herring SW, Liu ZJ, Rafferty KL, Baldwin MC, Salamati A, Cunningham C, et al. Repeated botulinum treatment of rabbit masseter causes cumulative tissue damage. Arch Oral Biol 2022 ;141:105480. doi: 10.1016/j.archoralbio.2022.105480
Long H, Liao Z, Wang Y, Liao L, Lai W. Efficacy of botulinum toxins on bruxism: An evidence-based review. Int Dent J 2012;62(1):1-5. doi: 10.1111/j.1875-595X.2011.00085.x
Weir CB, Jan A. BMI classification percentile and cut off points. [updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541070/
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Buddhchinaraj Phisanulok Hospital
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
