Abstract
Mandibular asymmetry often requires orthognathic surgery, and postsurgical relapse remains a concern. The masseter muscle may influence stability, but most studies have emphasized volumetric rather than qualitative changes. This prospective study evaluated 24 patients with mandibular asymmetry using ultrasonography preoperatively and at 1, 3, and 6 months after surgery. The parameters measured were thickness, stiffness ratio, echo intensity, and blood flow. The results showed significant postoperative adaptations. Masseter echo intensity increased markedly at 1 month (p < 0.001), peaked at 3 months (p = 0.042), and decreased toward baseline at 6 months (p < 0.001). Blood flow increased significantly from T1 to T2 (p < 0.001). Bite force dropped transiently at 1 month (p < 0.001) but recovered by 6 months (p < 0.001). At baseline, BMI correlated with echo intensity (r = 0.724, p < 0.001) and grip strength correlated with bite force (r = 0.705, p < 0.001). The stiffness ratio difference (contraction-rest) correlated with bite force (right: r = 0.629; left: r = 0.690). Relapse occurred in 25% of patients and correlated only with preoperative deviation and not ultrasound indices. Conclusions: Ultrasonography revealed meaningful qualitative muscle changes during recovery, though these were not strong predictors of relapse. Ultrasound remains a reliable, noninvasive tool for monitoring postoperative adaptation.