PMC7518480_01
(a) Side profile of the patient showing right hemifacial swelling extending from the preauricular region to the upper and lower lips on the same side. Linear postoperative scar is seen in the lower part of the swelling. (b) Shaded surface display image showing right hemifacial swelling, ipsilateral enlargement with drooping of the lips, and deviation of the mouth toward contralateral side
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F1
Downward deviation of the right corner of the mouth with ipsilateral hypertrophied lips and deviation of the mouth toward contralateral side were seen [Figure 1].
Orthopentogram shows right bony temporomandibular joint ankylosis, lack of structural organization, and loss of temporomandibular joint space with large mass of bone extending toward the skull base and into the genial notch. Left temporomandibular joint appears normal
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F2
Orthopentogram revealed the presence of marked expansion and remodeling of bones forming the right TMJ with associated TMJ ankylosis [Figure 2].
(a) Coronal computed tomography reformatted image (bone algorithm) shows enlarged right nasolacrimal duct (white arrow), (b) axial computed tomography image (bone algorithm) shows enlarged right foramen ovale (yellow arrow), (c) enlarged right inferior orbital foramen (red arrow) and greater palatine foramen (green arrow), and (d) enlarged right sphenopalatine foramen (blue arrow)
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F3
There was enlargement of foramen ovale, greater palatine foramen, sphenopalatine foramen, inferior orbital foramen, and nasolacrimal duct on right side. [Figure 3].
(a) Axial and (b) coronal computed tomography images (bone algorithm) show marked expansion with new bone formation, remodeling with articular surface irregularity of the right condylar head and temporal bone forming the glenoid fossa with the right temporomandibular joint ankylosis. There is an expansion with sclerosis of the right greater wing of the sphenoid bone and (c) coronal and (d) axial computed tomography images (soft tissue window) show fatty infiltration of the right side of the cheek, masticator space, buccal space, parotid gland, masseter, medial and lateral pterygoid muscles, upper lip, and right half of the tongue
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F4
Fatty infiltration was also seen in the upper and lower lips and right half of the tongue [Figure 4].
Volume-rendered images (a) and (b) show hypertrophied-ankylosed bony mass involving the right temporomandibular joint with loss of structural organization and preserved sigmoid notch. On the right side, the upper molar and premolar teeth are absent. Rest of the teeth are malaligned
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F5
Volume-rendered image revealed bony ankylosed mass involving the right TMJ [Figure 5].
Intraoperative image of the patient showing excision of the ankylosed bony mass
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F6
Surgical excision of ankylosed mass was done along with temporalis muscle interposition by the department of oral maxillofacial surgery [Figure 6].