Masseter muscle pressure injury: First report of a prone position complication in patients with COVID-19.
Adèle Rohée-Traoré, Jean-Daniel Kün-Darbois, Sophie Boucher
PMID 35396096WHAT IT FOUND
A patient developed a suspected masseter muscle pressure injury after prolonged prone positioning in ICU.
At follow-up, swelling resolved, but limited mouth opening and chewing pain remained disabling.
Key findings
01After the first 16-hour intubated prone period, left hemifacial swelling was noticed, with an 8 cm painful indurated cheek and 25 mm trismus; CT showed an enlarged heterogeneous masseter.
02Two days after starting analgesics and antibiotic prophylaxis, pain and swelling gradually decreased and a large parotido-masseteric ecchymosis appeared.
03Two months after hospital discharge, swelling had completely disappeared, but 30 mm limitation of buccal opening and masticatory pain remained disabling, and the patient declined prescribed maxillofacial physiotherapy.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only one patient is described, so this cannot show how common the injury is or whether prone positioning caused it. The authors state the diagnosis and pathophysiology lacked objective confirmation, such as creatine phosphokinase levels. The patient declined the prescribed maxillofacial physiotherapy, so its effect on persistent mouth-opening limitation and pain cannot be judged. The prevention and monitoring steps are drawn from the Discussion and are not tested interventions.
The easy way to misread this
Do not read this as proof that prone positioning caused masseter muscle injury or that the described prevention and physiotherapy measures work. It is a single case, and the authors state the diagnosis and pathophysiology lacked objective confirmation.