Do I Have Masseter Muscle Dehiscence?

Q: Dr. Eppley, Across the old implant design, CT scan, and picture, are you able to assess whether I have masseter muscle dehiscence? Is it possible that I don’t, and that my current implants poke out without having “broken” the masseter?

If I do have jaw dehiscence, how can that affect the visual outcome of the new implants? (Must I expect repeated implant reveal?)

Does the new implant design need to take any of this into consideration? 

A: The scan is not going to tell you whether you have a soft tissue problem like masseter muscle dehiscence without a special 3D scan that uses soft tissue windows. That is more of a clinical diagnosis, meaning if you bite down where does the bulge of the muscle….over the lower jaw angle or higher up? Having had a combined SSRO with immediate placement of jaw angle implants that is a primary set up for muscle dehiscence.

Implant reveal, or breaking through the muscle, is when the muscle sling is intact but the implant design. square out the angle too much, and the implant is sticking beyond the posterior of the muscle. (like your existing implant design. You have to remember the shape of the follows the shape of the bone. Since all jaw angles are rounder in shape a square jaw angle implant shape can do exactly that.

The current implant design reflects your preference for the shape of the jaw angles not mine. I would not have it so square but have tolerated a shape I am not fond of, due to the risks of muscle dehiscence or implant reveal, because it would probably not being any worse than what exists now because of the encapsulated implant pocket.

Dr. Barry Eppley

World-Renowned Plastic Surgeon