Removal of Calcifications in the masseter muscle surgery

Etiology behind formation of calcifications in soft tissues

Calcifications of soft tissues is an abnormal presentation. It can be found to occur in arteries, connective tissue, muscles, subcutaneous tissues, cysts, heart valves etc. The most common biochemical etiology behind formation of these calcifications is deficiency of vitamin K or improper absorption of calcium in the body.

Calcifications can also occur in facial structures. Head and neck cancers can cause calcifications in the head and neck region although idiopathic calcification is more common. Surgical procedures are commonly performed to remove these calcifications when they interfere with normal function or are esthetically disfiguring.

Oral and maxillofacial surgeons commonly perform these surgeries when it involves the oral cavity and related structures. Other procedures performed by this surgical specialty include cosmetic surgery procedures of the face, temporomandibular joint surgery, masseter muscle surgery, orthognathic surgery, complicated tooth extractions, placement of dental implants along with bone grafting procedures, etc.

Board certified plastic surgeons who hold dual degrees in medicine and dentistry perform facial cosmetic procedures in the western countries.

Patient with complaints of swelling in the left face

This patient is a 28-year-old male from Alapuzha in Kerala, India who started noticing a mild swelling and pain in his left lower face for the past 6-8 months. The first time this swelling had presented was around two years ago when he had been diagnosed as having calcifications in his left masseter muscle by a local oral surgeon. Masseter muscle surgery had been performed and these calcifications had been surgically removed in his hometown, but the pain and swelling had recurred again.

He visited the same oral surgeon who had examined him and said that he needed to undergo surgical removal of the calcifications at a specialty oral surgical center and had referred him to our hospital for definitive management. Our hospital is a renowned center for oral and maxillofacial surgery in India. We are also a renowned center for facial cosmetic surgery in India

What causes calcifications in muscle tissue?

Calcifications or deposition of calcium in muscle tissue can occur whenever there is a change in serum chemistry. Calcium deposits can form in connective tissue, blood vessels or in organs. This is always deleterious to the tissues because of pain and swelling, which would affect the normal function of the tissue. Calcification of blood vessels is an especially dangerous sign because it can lead to slowing down of flow of blood, which can even lead to tissue necrosis of the organ being supplied by that particular vessel.

Some are idiopathic while others can be the manifestation of a pathological process. Biochemical testing needs to be done to rule out any underlying pathological conditions. In case it is idiopathic, it can be left as is or can be excised if it causes pain or is esthetically compromising. It was completely idiopathic in this above stated case with no underlying pathological condition.

Initial presentation at our hospital for consultation and examination
Dr SM Balaji, facial cosmetic surgeon, examined the patient and ordered comprehensive imaging and biochemical studies. This revealed that the patient had a noticeable swelling on the left side of his face. The swelling became pronounced when the patient clenched his jaws and disappeared when the patient’s muscles were at rest. A 3D CT scan that had been taken of the region revealed two calcifications lying within the left masseter muscle.

It was explained in detail to the patient. The plan was to remove the two calcifications surgically through an intraoral approach so as to avoid causing any residual facial scars. The patient was in complete agreement with the treatment plan and signed the consent for surgery. It was explained that the calcifications could possibly recur again as they have recurred after being excised once previously.

Successful surgical removal of the two calcifications

Under general anesthesia, an incision was made in the left buccal mucosa and dissection was carried down to the masseter muscle. The masseter muscle was carefully dissected with exposure of the two calcifications. These were then gently teased and removed from the muscle tissue. Closure of the incision was then done using resorbable suture.

The two calcifications were biopsied and returned as fibrosis and nodular calcifications. The patient was informed of the results and reassured.
Patient very happy with the results

The patient was very pleased to see that the two stones had been completely excised. He said that the pain and the swelling was gone and that he could open his mouth to the fullest extent again without any discomfort.

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