PMC6018275_01
(a) Preoperative view of patient at time of presentation. (b) Preoperative mouth opening of the patient = 15 mm with mild deviation of the mandible to the injured (right) side
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F1
The patient was lost on follow-up but he reported with the chief complaint of reduced mouth opening [Figure 1a]. Maximum interincisal mouth opening was 15 mm with mild deviation of the mandible to the injured side [Figure 1b].
Waters' view revealed loss of normal architecture of the coronoid process and zygomatic arch on the right side (red circle). Left zygomatic arch is fairly visible
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F2
Water's view [Figure 2] revealed an irregular-shaped radio-opaque mass over the right zygomatic region.
(a-c) Computed tomography showing irregular bony growth from the right coronoid process of the mandible uniting zygomatic arch
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F3
There was presence of an irregular bony growth from the superior portion of the right coronoid process, uniting with the temporal surface of the zygoma which showed bone formation on its medial aspect having homogeneous bony texture [Figures 3a-c].
(a) Ankylotic bony mass exposed. (b) Resection of ankylotic mass. (c) After the ostectomy, a gap of at least 1.5 cm between the roof of the fossa and the mandible was created. (d) Intraoperative mouth opening achieved: 40 mm
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F4
It was found that the enlarged coronoid had fused with the mushroom-shaped bone over the zygoma [Figure 4a]. As the next stage of the procedure, ostectomy was performed by means of osteotomes and fissure burs removing the ankylotic osseous mass [Figure 4b]. Hence, ipsilateral condylectomy was also performed and a gap of 1.5 cm was created between roof of the glenoid fossa and the mandible [Figure 4c]. Following this procedure, mouth opening of 40 mm was achieved at the end of surgery [Figure 4d].
Mouth opening after 6 months = 40 mm
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F5
The unforced mouth opening increased to 35 mm, 2 months after surgery and 40 mm after 6 months of surgery [Figure 5].
(a-c) Computed tomogram taken 1 month after surgery showing level of resection and gap between roof of the glenoid fossa and the mandible and also reconstructed zygomatic arch secured with miniplates
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F6
The patient was subjected to postoperative investigations which included orthopantomogram and computed tomogram [Figures 6a-c].