Masseter Muscle Cysts

Masseter muscle cysts are sac-like lesions filled with fluid or semi-solid material that develop within the masseter muscle, one of the main muscles responsible for chewing. Although uncommon, these cysts can cause facial swelling, pain on chewing, and difficulty opening the jaw if untreated. A cyst is defined as “a sac that may be filled with air, fluid or other material” and can form in any part of the body, including soft tissues and muscles . Masseter muscle cysts arise due to a variety of factors—parasitic infections, developmental anomalies, trauma, or blockage of nearby structures PMC.

Anatomy of the Masseter Muscle

The masseter is a powerful quadrangular muscle on each side of the face that elevates (closes) and slightly protrudes the lower jaw (mandible). It has three heads—superficial, deep, and coronoid—and lies just beneath the skin of the cheek .

• Origin

  • Superficial head: Zygomatic arch and maxillary process of the zygomatic bone

  • Deep head: Medial surface and posterior third of the zygomatic arch

  • Coronoid head: Coronoid process of the mandible

• Insertion

  • Angle and lateral surface of the ramus of the mandible

• Blood Supply

  • Primarily the masseteric artery, a branch of the maxillary artery

• Nerve Supply

  • Masseteric nerve (branch of mandibular division, V₃, of the trigeminal nerve)

• Functions

  1. Elevates the mandible to close the mouth

  2. Protrudes the mandible slightly

  3. Retracts the mandible (deep fibers)

  4. Ipsilateral excursion (side-to-side movement)

  5. Stabilizes the temporomandibular joint (TMJ)

  6. Assists in forceful clenching of the teeth

Types of Masseter Muscle Cysts

1. Parasitic Cysts (Cysticercosis): Larval Taenia solium forms a fluid-filled cyst in muscle tissue Tropical Medicine Research Portal

2. Hydatid Cysts: Echinococcus granulosus infestation leading to hydatid cysts in muscle IJSRPubMed

3. Epidermoid (Epidermal Inclusion) Cysts: Trauma implants surface skin cells into deeper tissues, forming a cyst

4. Dermoid Cysts: Congenital entrapment of ectodermal elements during embryonic development

5. Lymphoepithelial Cysts: Rare benign cysts from parotid or ectopic lymphoid tissue in the cheek

6. Lymphatic Malformations (Cystic Hygroma): Congenital malformations of lymphatic channels, presenting as macro- or microcystic clusters

7. Salivary Duct (Sialocyst) Cysts: Obstruction of salivary ducts (e.g., parotid) leading to fluid accumulation

Causes

1. Ingestion of Taenia solium eggs (cysticercosis) PMC

2. Echinococcus granulosus infection (hydatid cyst) IJSRSelçuk Tıp Dergisi

3. Traumatic implantation of epidermal cells (epidermoid cyst)

4. Entrapment of ectodermal tissue during development (dermoid cyst)

5. Branchial cleft remnant tissue (branchial cleft cyst)

6. Obstruction of salivary ducts (mucous retention cyst)

7. Embryological lymphatic malformation

8. Iatrogenic seeding of surface cells during surgery

9. Cystic degeneration of benign neoplasms

10. Hemorrhagic pseudocyst post-trauma

11. Encapsulated abscess formation

12. Radiation-induced tissue necrosis

13. Muscle infarction with cystic change

14. Vascular lesion cystic transformation

15. Inflammatory granuloma with central cyst

16. Sarcoid nodule cystic degeneration

17. Metastatic tumor central necrosis

18. Degenerative myxoid change

19. Genetic predisposition (rare syndromes)

20. Idiopathic (unknown)

Symptoms

1. Cheek swelling

2. Pain on chewing

3. Palpable cheek lump

4. Mass fixed during teeth clench

5. Tenderness to touch

6. Trismus (limited mouth opening)

7. Facial asymmetry

8. Fluctuant or firm consistency

9. Skin warmth or redness

10. Visible central punctum (epidermoid)

11. Radiating ear/neck pain

12. Intermittent aching

13. Headache

14. Altered bite alignment

15. Numbness or tingling

16. Chronic fistula formation

17. Recurrence after prior drainage

18. Fever with infection

19. Ulceration if superficial

20. Difficulty swallowing

Diagnostic Tests

1. Physical examination and palpation

2. Ultrasound for cystic structure

3. Doppler ultrasound for vascular flow

4. MRI with ring enhancement

5. CT scan for anatomy IJSR

6. X-ray or panoramic radiograph

7. Sialography for duct evaluation

8. Fine-needle aspiration cytology (FNAC)

9. Histopathology (H&E stain)

10. Immunohistochemistry

11. ELISA for cysticercosis

12. Indirect hemagglutination for hydatid cyst PMC

13. PCR for parasite DNA

14. CBC for inflammatory markers

15. Eosinophil count in parasitic cases

16. ESR and CRP levels

17. Arthrography of TMJ

18. Transillumination test

19. Sialendoscopy

20. Incisional or excisional biopsy

Non-Pharmacological Treatments

1. Open surgical excision

2. En bloc cystectomy

3. Intraoral approach removal

4. Lateral cervical incision excision

5. Marsupialization

6. Micro-marsupialization

7. Ultrasound-guided aspiration

8. Needle drainage

9. PAIR (aspiration–injection–reaspiration) for hydatid PubMed

10. Cryotherapy

11. Laser ablation

12. Radiofrequency ablation

13. Arthrocentesis of TMJ

14. Heat therapy (warm compress)

15. Cold compresses

16. Moist heat packs

17. Jaw-stretching exercises

18. Physical therapy

19. Transcutaneous electrical nerve stimulation (TENS)

20. Myofascial release massage

21. Acupuncture

22. Biofeedback for bruxism

23. Dental night-guard/splint

24. Soft-diet modification

25. Oral hygiene optimization

26. Cheek taping for support

27. Relaxation and stress management

28. Botulinum toxin injection (adjunct)

29. Jaw relaxation techniques

30. Avoidance of gum chewing

Drugs

1. Albendazole (antiparasitic) SciELO

2. Praziquantel (antiparasitic)

3. Mebendazole (antihelminthic) SciELO

4. Niclosamide (tapeworm)

5. Ivermectin (broad-spectrum antiparasitic)

6. Prednisone (steroid)

7. Ibuprofen (NSAID)

8. Acetaminophen (analgesic)

9. Triamcinolone (steroid injection)

10. Amoxicillin–clavulanate (antibiotic)

11. Clindamycin (antibiotic)

12. Metronidazole (antibiotic)

13. Doxycycline (antibiotic)

14. Pilocarpine (sialogogue)

15. Cyclobenzaprine (muscle relaxant)

16. Diazepam (sedative muscle relaxant)

17. OK-432 (Picibanil) (sclerosing agent)

18. Bleomycin (sclerotherapy)

19. Doxorubicin (adjunct in sclerotherapy)

20. Lidocaine (local anesthetic)

Surgical Options

1. Excisional biopsy

2. En bloc cystectomy

3. Intraoral surgical removal

4. Lateral cervical incision excision

5. Marsupialization

6. Micro-marsupialization

7. PAIR technique PubMed

8. Laser excision

9. Cryosurgical removal

10. Superficial parotidectomy (for sialocyst)

Prevention Strategies

1. Cook pork thoroughly (avoid cysticercosis)

2. Practice hand hygiene after handling raw meat

3. Deworm pets to prevent hydatid disease

4. Avoid raw or undercooked meat

5. Maintain good oral hygiene

6. Treat salivary gland stones/infections promptly

7. Wear protective gear to prevent facial trauma

8. Use meticulous technique in facial surgery

9. Regular dental check-ups

10. Avoid excessive gum chewing

When to See a Doctor

See a healthcare professional if you have:

• Cheek swelling lasting over two weeks

• Pain or difficulty chewing

• A firm or fluctuant mass in your cheek

• Restricted mouth opening

• Fever, redness, or warmth over a facial lump

Frequently Asked Questions (FAQs)

1. What causes a masseter muscle cyst?
   Infections, developmental anomalies, trauma, or blockage of nearby ducts can all play a role.

2. Are masseter cysts painful?
   They often cause pain when chewing or pressing on the mass.

3. Can they resolve on their own?
   Most do not shrink without intervention and may grow or become infected.

4. How is a masseter cyst diagnosed?
   Physical exam, imaging (ultrasound, MRI, CT), and sometimes biopsy.

5. Are they common?
   No—cysts in the masseter muscle are relatively rare.

6. What’s the treatment for parasitic cysts?
   Antiparasitic medications (e.g., albendazole) often combined with surgery.

7. Can children get these cysts?
   Yes—especially lymphatic malformations and developmental cysts.

8. Is surgery always needed?
   Many need removal, though small or asymptomatic cysts can sometimes be monitored.

9. What if a cyst bursts?
   It can cause inflammation or infection—seek medical help promptly.

10. Can cysts recur after removal?
    Yes—especially if they’re not completely excised or are lymphatic in origin.

11. How can I prevent parasitic cysts?
    Good hygiene, thorough cooking of meat, and pet deworming.

12. Are imaging tests safe?
    Ultrasound is very safe; MRI has no radiation; CT is used judiciously.

13. Difference between cyst and tumor?
    A cyst is a fluid-filled sac; a tumor is an abnormal tissue mass.

14. Can cysts limit jaw movement?
    Yes—larger cysts may restrict mouth opening and chewing.

15. When is urgent care needed?
    Rapidly growing mass, severe pain, fever, or breathing/swallowing difficulty.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: April 24, 2025.

Previous

Masseter Muscle Tumors

Next

Masseter Muscle Infections