PMC5750776_01
Preoperative maximal interincisal opening of 22 mm.
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The maximal interincisal mouth opening was 22 mm with lateral movements to the right and left of 5 mm and 6 mm, respectively (Fig. 1).
Preoperative orthopantomogram showing the elongated mandibular coronoid process projecting into the infratemporal fossa.
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Angle class I occlusion. A panoramic radiography showed bilateral enlargement of the mandibular coronoid process projecting into the infratemporal fossa (Fig. 2).
Preoperative Cone Beam Computed Tomography scan. (A) Coronal image showing close approximation of the right coronoid process to the medial surface of the zygomatic bone. (B) Coronal image showing close approximation of the left coronoid process to the medial surface of the zygomatic bone (C) Sagittal image showing enlargement of the right coronoid process impinged on the zygomatic bone.
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Cone beam computed tomography with three-dimensional recons-truction revealed bilateral elongated mandibular coronoid processes impinging upon the zygomatic bone during mouth opening (Fig. 3).
Intraoperative clinical photo. (A) The elongated mandibular coronoid process exposed by an intraoral approach. (B) A low coronoidectomy performed with reciprocating saw.
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A channel retractor was placed into the sigmoid notch and a ramus clamp was secured over the coronoid process before a low coronoidectomy was performed from the sigmoid notch to the anterior oblique ridge with a reciprocating saw (Fig. 4).
Intraoperative clinical photo. (A) The mandibular coronoid processes after coronoidectomy. (B) The resected coronoid processes. (C) Frontal image of the resected coronoid processes.
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The coronoid process on both sides was removed with forceps and surgical recontouring of the mandibular ramus was performed with a drill (Fig. 5).
The interincisal mouth opening increased to 42 mm in the operation room.
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The interincisal mouth opening increased to 42 mm in the operation room (Fig. 6).
Postoperative orthopantomogram demonstrating successful removal of the coronoid processes.
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Post-operative panoramic and three-dimensional CT demonstrated successful bilateral coronoidectomy with no interferences between the mandible and zygomatic bone during mouth opening (Figs. 7 and 8).
Postoperative Cone Beam Computed Tomography scan. (A) Coronal image showing no interference between the coronoid processes and the medial surface of the zygomatic bone and arch. (B) Sagittal image showing the resected coronoid process with no interference with the zygomatic bone.
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Post-operative panoramic and three-dimensional CT demonstrated successful bilateral coronoidectomy with no interferences between the mandible and zygomatic bone during mouth opening (Figs. 7 and 8).
Three months postoperative maximal interincisal opening of 32 mm.
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Three months after the operation, a satisfactory mouth opening of 32 mm was achieved (Fig. 9).