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Mouth opening limitation caused by coronoid hyperplasia: a report of four cases.

Kim SM, Lee JH, Kim HJ, Huh JK - J Korean Assoc Oral Maxillofac Surg (2014)

Bottom Line: The elongated coronoid processes impinge on the medial surfaces of the zygomatic arches when opening the mouth, which limits movement of the mandible and leads to trismus.However, computed tomography can help with the diagnosis, and the condition can be treated by surgery and postoperative physical therapy.Three were successfully treated with a coronoidectomy and postoperative physical therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea.

ABSTRACT
Coronoid process hyperplasia is a rare condition that causes mouth opening limitation, otherwise known as trismus. The elongated coronoid processes impinge on the medial surfaces of the zygomatic arches when opening the mouth, which limits movement of the mandible and leads to trismus. Patients with trismus due to coronoid process hyperplasia do not have any definite symptoms such as temporomandibular joint pain or sounds upon clinical examination, and no significant abnormal signs are observed on panoramic radiographs or magnetic resonance images of the temporomandibular joint. Thus, the diagnosis of trismus is usually very difficult. However, computed tomography can help with the diagnosis, and the condition can be treated by surgery and postoperative physical therapy. This paper describes four cases of patients who visited our clinic for trismus and were subsequently diagnosed with coronoid process hyperplasia. Three were successfully treated with a coronoidectomy and postoperative physical therapy.

No MeSH data available.


Related in: MedlinePlus

A. Magnetic resonance imaging of the right temporomandibular joint in a closed-mouth position. B. An open-mouth position in case 2.
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Figure 2: A. Magnetic resonance imaging of the right temporomandibular joint in a closed-mouth position. B. An open-mouth position in case 2.

Mentions: Magnetic resonance images were obtained with the expectation that anterior disc displacement without reduction and a masticatory muscle disorder were responsible for the patient's condition, based on physical examinations.(Fig. 2. A, 2. B) The images revealed anterior disc displacement with reduction on the left TMJ and adhesion of the right articular disc. Anterior positioning splint therapy and botulinum toxin injection were used to relieve the stiffness of the bilateral masseter muscles, but no improvement in TMJ pain or MIO was observed. Arthroplasty of the right TMJ was performed to resolve the adhesion of the articular disc, but the movement of the mandible was not satisfactory in the operating room. A few months after surgery, the patient continued to complain of TMJ pain, a grinding sound in the bilateral TMJs, and mouth opening limitation. CT images were taken to determine the possibility of TMJ osteoarthritis or neoplasm, and an elongated right coronoid process and heterotopic bone formation were detected on the medial and inferior surfaces of the right zygomatic arch.(Fig. 3A-C)


Mouth opening limitation caused by coronoid hyperplasia: a report of four cases.

Kim SM, Lee JH, Kim HJ, Huh JK - J Korean Assoc Oral Maxillofac Surg (2014)

A. Magnetic resonance imaging of the right temporomandibular joint in a closed-mouth position. B. An open-mouth position in case 2.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4279969&req=5

Figure 2: A. Magnetic resonance imaging of the right temporomandibular joint in a closed-mouth position. B. An open-mouth position in case 2.
Mentions: Magnetic resonance images were obtained with the expectation that anterior disc displacement without reduction and a masticatory muscle disorder were responsible for the patient's condition, based on physical examinations.(Fig. 2. A, 2. B) The images revealed anterior disc displacement with reduction on the left TMJ and adhesion of the right articular disc. Anterior positioning splint therapy and botulinum toxin injection were used to relieve the stiffness of the bilateral masseter muscles, but no improvement in TMJ pain or MIO was observed. Arthroplasty of the right TMJ was performed to resolve the adhesion of the articular disc, but the movement of the mandible was not satisfactory in the operating room. A few months after surgery, the patient continued to complain of TMJ pain, a grinding sound in the bilateral TMJs, and mouth opening limitation. CT images were taken to determine the possibility of TMJ osteoarthritis or neoplasm, and an elongated right coronoid process and heterotopic bone formation were detected on the medial and inferior surfaces of the right zygomatic arch.(Fig. 3A-C)

Bottom Line: The elongated coronoid processes impinge on the medial surfaces of the zygomatic arches when opening the mouth, which limits movement of the mandible and leads to trismus.However, computed tomography can help with the diagnosis, and the condition can be treated by surgery and postoperative physical therapy.Three were successfully treated with a coronoidectomy and postoperative physical therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea.

ABSTRACT
Coronoid process hyperplasia is a rare condition that causes mouth opening limitation, otherwise known as trismus. The elongated coronoid processes impinge on the medial surfaces of the zygomatic arches when opening the mouth, which limits movement of the mandible and leads to trismus. Patients with trismus due to coronoid process hyperplasia do not have any definite symptoms such as temporomandibular joint pain or sounds upon clinical examination, and no significant abnormal signs are observed on panoramic radiographs or magnetic resonance images of the temporomandibular joint. Thus, the diagnosis of trismus is usually very difficult. However, computed tomography can help with the diagnosis, and the condition can be treated by surgery and postoperative physical therapy. This paper describes four cases of patients who visited our clinic for trismus and were subsequently diagnosed with coronoid process hyperplasia. Three were successfully treated with a coronoidectomy and postoperative physical therapy.

No MeSH data available.


Related in: MedlinePlus