PMC4979324_01
Preoperative photograph showing limited mouth opening
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F1
A 32-year-old male reported to the Department of Oral and Maxillofacial surgery Armed Forces Medical College, Pune with the limitation of mouth opening since past 7 years [Figure 1].
Orthopantomogram showing marked changes in the temporomandibular joint anatomy and elongated coronoid process
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F2
An orthopantomogram (OPG) [Figure 2] showed marked anatomical changes in both the joints and an elongated coronoid process.
(a) Cone-beam computed tomography showing right condylar head fused to glenoid fossa, and hypertrophied coronoid process. (b) Left side showing fractured articular surface, narrowing of joint space and irregularity in the articular surface of the condyle
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F3
Cone-beam computed tomography (CBCT) showed right condylar head fused to glenoid fossa, fractured articular surface of left TMJ and narrowing of joint space and hypertrophied coronoid process [Figure 3].
(a) Osteoarthrectomy done. (b) Gleniod fossa interpositioned with temporalis fascia. (c) L-shaped osteotomy done
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F4
Osteoarthrectomy was carried out to create a gap of about 1 cm [Figure 4a] and the coronoid process was excised. Gleniod fossa was interpositioned with posteriorly pedicled temporalis myofascial flap [Figure 4b].
Zurich Pediatric Ramus Distractor (KLS Martin, Tuttlingen, Germany) was placed across the osteotomy site
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F5
Tuttlingen, Germany) was predetermined. The osteotomy was completed, and the distractor device was returned to its predetermined position [Figure 5].
Orthopantomogram taken at the end of distraction
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F6
On completion of 8mm of distraction, OPG was taken [Figure 6].
One year postoperative clinical picture showing mouth opening of 38 mmand
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F7
The patient was followed up for 12 months and mouth opening of 38 mm was achieved without any anterior open bite [Figure 7].