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Masticatory muscle tendon-aponeurosis hyperplasia: A new clinical entity of limited mouth opening

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ABSTRACT

Limited mouth opening is a common health problem that interferes with eating, makes examination of the oral cavity difficult, and may increase the mortality rate during emergency intubation. Here we introduce a disease designated as masticatory muscle tendon-aponeurosis hyperplasia, which is a new clinical condition of limited mouth opening. Most oral surgeons and dentists are still unaware of this disease condition, thus increasing the risk of incorrect diagnosis as some other disease, such as temporomandibular joint disorder. We will review the clinical features, epidemiology, pathophysiology, etiology, diagnosis, treatment, and prognosis of this disease and also appraise the literature available on the subject.

No MeSH data available.


Surgical procedure. (A) Tendon of the temporal muscle. (B) Excised coronoid process.
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fig0025: Surgical procedure. (A) Tendon of the temporal muscle. (B) Excised coronoid process.

Mentions: Previously, we have reported a case presentation with videos [32], where we introduce the surgical procedures for MMTAH patients in detail. Surgical treatment is performed under general anesthesia. Muscular relaxation does not improve restricted mouth opening. Conforming to the incision line for sagittal split ramus osteotomy, an incision is made in the oral mucosa and the anterior margin of the mandibular ramus is exposed. The fascia of the masseter muscle on the outer aspect of the mandibular ramus will be visible, and on separating this fascia, the anterior margin of the masseter muscle can be clearly identified. The aponeurosis is revealed and exhibits a silvery-white color on exfoliating upward and outward (Fig. 5A). The aponeurosis is detached from the muscle tissue and excised as large as possible using scissors or electrosurgical knives. If the masseter muscle appears hard on palpation, the aponeurosis may be located within the muscle. Aponeurectomy of the masseter muscle should be performed bilaterally. The periosteum on the anterior margin of the mandibular ramus can be exfoliated upward. An abnormal sound can be heard on exfoliating this periosteum with a raspatory. The temporal tendon attached to the coronoid process is then exposed and subsequently removed from the coronoid process (Fig. 5B). Because the coronoid process does not interfere with the zygomatic bone, its apex can easily be identified. Although the posterior tendon should be cut as much as possible, it is often difficult to excise it completely. By clasping the coronoid process tightly with the help of a Pean or Kocher, we can excise it using cutting instruments such as the Lindemann drill. After confirming that mouth has opened >45 mm, the surgical incision can be closed using sutures. Continuous intraoral drainage is effective in reducing postoperative swelling and conducting mouth opening training. Immediate oral intake and training in intentional clenching are required postoperatively to prevent open bite. Mouth opening training should be started 5 days after surgical treatment. The training involves widely opening of the mouth for 30 s with the help of a mouth opener, which is repeated more than 3 times, using analgesics to control the pain. The patient is discharged once they can open the mouth >40 mm without using the mouth opener. This training should be continued for at least 6 months.


Masticatory muscle tendon-aponeurosis hyperplasia: A new clinical entity of limited mouth opening
Surgical procedure. (A) Tendon of the temporal muscle. (B) Excised coronoid process.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5382786&req=5

fig0025: Surgical procedure. (A) Tendon of the temporal muscle. (B) Excised coronoid process.
Mentions: Previously, we have reported a case presentation with videos [32], where we introduce the surgical procedures for MMTAH patients in detail. Surgical treatment is performed under general anesthesia. Muscular relaxation does not improve restricted mouth opening. Conforming to the incision line for sagittal split ramus osteotomy, an incision is made in the oral mucosa and the anterior margin of the mandibular ramus is exposed. The fascia of the masseter muscle on the outer aspect of the mandibular ramus will be visible, and on separating this fascia, the anterior margin of the masseter muscle can be clearly identified. The aponeurosis is revealed and exhibits a silvery-white color on exfoliating upward and outward (Fig. 5A). The aponeurosis is detached from the muscle tissue and excised as large as possible using scissors or electrosurgical knives. If the masseter muscle appears hard on palpation, the aponeurosis may be located within the muscle. Aponeurectomy of the masseter muscle should be performed bilaterally. The periosteum on the anterior margin of the mandibular ramus can be exfoliated upward. An abnormal sound can be heard on exfoliating this periosteum with a raspatory. The temporal tendon attached to the coronoid process is then exposed and subsequently removed from the coronoid process (Fig. 5B). Because the coronoid process does not interfere with the zygomatic bone, its apex can easily be identified. Although the posterior tendon should be cut as much as possible, it is often difficult to excise it completely. By clasping the coronoid process tightly with the help of a Pean or Kocher, we can excise it using cutting instruments such as the Lindemann drill. After confirming that mouth has opened >45 mm, the surgical incision can be closed using sutures. Continuous intraoral drainage is effective in reducing postoperative swelling and conducting mouth opening training. Immediate oral intake and training in intentional clenching are required postoperatively to prevent open bite. Mouth opening training should be started 5 days after surgical treatment. The training involves widely opening of the mouth for 30 s with the help of a mouth opener, which is repeated more than 3 times, using analgesics to control the pain. The patient is discharged once they can open the mouth >40 mm without using the mouth opener. This training should be continued for at least 6 months.

View Article: PubMed Central - PubMed

ABSTRACT

Limited mouth opening is a common health problem that interferes with eating, makes examination of the oral cavity difficult, and may increase the mortality rate during emergency intubation. Here we introduce a disease designated as masticatory muscle tendon-aponeurosis hyperplasia, which is a new clinical condition of limited mouth opening. Most oral surgeons and dentists are still unaware of this disease condition, thus increasing the risk of incorrect diagnosis as some other disease, such as temporomandibular joint disorder. We will review the clinical features, epidemiology, pathophysiology, etiology, diagnosis, treatment, and prognosis of this disease and also appraise the literature available on the subject.

No MeSH data available.