How the fuck is the masseter muscle reattached?

[Acromegaly_Chad]

The masseter muscle originates from the inferior border and medial surface of the zygomatic arch and inserts broadly onto the lateral surface of the ramus of the mandible and the coronoid process. The medial pterygoid originates from the region of the lateral pterygoid plate and inserts onto the medial surface of the ramus. At the inferior border of the mandible, both the masseter and medial pterygoid muscles have strong tendinous insertions that adhere in proximity to the periosteum and, as a group, are often referred to as the PS.

However, what I do not understand is how the masseter muscle is reattached when you get a custom made jaw angle implant just like this:

Anybody here has an idea how the masseter is reattached ? According to Yaremchuk it's done with small sutures (which could explain why the implant has 2 little holes at the bottom) but I don't really see how this could withstand the enormous bite force of several hundred pounds.

 

[randomvanish]

The masseter muscle originates from the inferior border and medial surface of the zygomatic arch and inserts broadly onto the lateral surface of the ramus of the mandible and the coronoid process. The medial pterygoid originates from the region of the lateral pterygoid plate and inserts onto the medial surface of the ramus. At the inferior border of the mandible, both the masseter and medial pterygoid muscles have strong tendinous insertions that adhere in proximity to the periosteum and, as a group, are often referred to as the PS.

View attachment 1137760

However, what I do not understand is how the masseter muscle is reattached when you get a custom made jaw angle implant just like this:

View attachment 1137761


Anybody here has an idea how the masseter is reattached ? According to Yaremchuk it's done with small sutures (which could explain why the implant has 2 little holes at the bottom) but I don't really see how this could withstand the enormous bite force of several hundred pounds.

also why that implant has weird indentations ?

 

[randomvanish]

@RealSurgerymax

 

[RealSurgerymax]

The masseter muscle originates from the inferior border and medial surface of the zygomatic arch and inserts broadly onto the lateral surface of the ramus of the mandible and the coronoid process. The medial pterygoid originates from the region of the lateral pterygoid plate and inserts onto the medial surface of the ramus. At the inferior border of the mandible, both the masseter and medial pterygoid muscles have strong tendinous insertions that adhere in proximity to the periosteum and, as a group, are often referred to as the PS.

View attachment 1137760

However, what I do not understand is how the masseter muscle is reattached when you get a custom made jaw angle implant just like this:

View attachment 1137761


Anybody here has an idea how the masseter is reattached ? According to Yaremchuk it's done with small sutures (which could explain why the implant has 2 little holes at the bottom) but I don't really see how this could withstand the enormous bite force of several hundred pounds.

@RealSurgerymax

In most circumstances it does not need to be reattached since the periosteum elevated for the implant is continuous with periosteum that wasn't elevated. This is what holds it into place and over time those tissues stretch to accomadate the implant nicely. However the masseter muscle can become detached early on with a pterygoid sling tear, especially if the implant is very large or if the subperiosteal dissection was sloppy and traumatic.

In those circumstances reattaching the muscle to the bone is possible but difficult, and will involve scars on the face. Doing this through an intraoral incision is is not going to work. It will require a Risdons Approach:

Many small holes are drilled through the bottom of mandibular border at the jaw angle and sutures secure the masseter back down. In the cas of an implant you could attempt to do the same over the implant with a higher chance of failure.

At best, only a couple of sutures could be placed as “helper sutures” to prevent a masseteric dehiscence to the implant through a normal intraoral incision that maybe what you heard about.

Remember biting forces are going to be limited by discomfort in the early healing stage.