Extra-articular fibrous ankylosis of the mandible after zygomatic fracture

Anterolateral thigh flap with a central hole for the repair of extensive oral defects in patients treated for chemotherapy-induced trismus

Trismus is a rare complication of chemotherapy. The usefulness of a modified anterolateral thigh (ALT) flap for the repair of extensive oral defects in patients treated for chemotherapy-induced trismus was evaluated. Between 2019 and 2021, three patients with chemotherapy-induced trismus underwent scar excision. A thinned ALT flap with a central hole was designed to repair the resultant oral mucosal defects. The patients were followed up for a mean 9.3 months (range 4-18 months). The mean pre- and intraoperative maximum inter-incisal opening (MIO) was 0.7 cm (range 0-2.0 cm) and 3.6 cm (range 3.4-3.7 cm), respectively, indicating a significant operative effect. MIO at the latest follow-up was 2.4 cm (range 1.5-3.5 cm). All of the flaps survived without complications. All patients achieved a good diet and were satisfied with the aesthetics. Thorough excision of the perioral scar and restoration with a modified ALT flap achieved satisfactory mouth opening and cosmetic effects in patients with chemotherapy-induced trismus.

Efficacy of temporomandibular joint arthroplasty and insertion of a Matthews device as treatment for ankylosis of the joint: a case series

Temporomandibular joint (TMJ) ankylosis is a condition in which bony or fibrous adhesion of the anatomical joint components results in loss of function. This is particularly distressing and debilitating for patients who struggle to maintain good oral hygiene, which results in additional pain, oral disease, and ultimately, a poor aesthetic profile. A retrospective chart review was carried out to document the cases of three patients who attended a single centre for the management of ankylosis of the TMJ. Consent for chart review and use of photographs was gained from each one. Charts were obtained, records reviewed, and each of the cases written up for presentation in a case series. All three underwent arthroplasty of the TMJ and insertion of Matthews devices (two patients unilateral, one bilateral). All were followed up postoperatively. They experienced significant improvements in vertical mouth opening which have been maintained to the present. The Matthews device allows movement and physiotherapy postoperatively whilst maintaining the surgically created space. This prevents impingement on the tissues placed between the glenoid fossa and mandible, and appears to prevent relapse and further ankylosis. To our knowledge, few studies to date have documented the use of the Matthews device following interpositional arthroplasty of the TMJ.

Strategy for the Treatment of Zygomatic-Coronoid Ankylosis

Zygomatic-coronoid ankylosis is a rare complication in maxillofacial trauma. Currently, less of 30 cases reported in the literature. The aim of this study was to report a case of zygomatic-coronoid ankylosis after trauma. A 26-year-old male, with zygomatic-coronoid ankylosis after 7 years of facial trauma, was treated by intraoral bilateral coronoidectomy. However, the literature continues to discuss the best approach, intraorally or extraorally. This study observed that the intraoral approach was easily performed and without complications.

Pseudoankylosis Between Lateral Pterygoid Plates and Mandible: Report of One Case

Temporomandibular joint (TMJ) ankylosis is the abnormal fusion of TMJ anatomic components that impedes free jaw movements. This restriction in motion ranges from minimal to a complete inability to open the jaw. This condition can be categorized as true ankylosis, which is attributed to pathologic conditions of the TMJ, or false ankylosis (pseudoankylosis), which describes restrictions of movement resulting from extracapsular abnormalities outside the TMJ. The literature shows that trauma is the leading cause of TMJ disorders and appears to be the most common cause of pseudoankylosis. Pseudoankylosis caused by pterygomandibular bony impingement has rarely been reported in the literature. This case report adds a new case of pseudoankylosis to the existing scanty literature, which was characterized by bilateral mechanical impingement between abnormally elongated lateral pterygoid plates and the coronoid processes of the mandible.

Ankylosis of the Coronoid Process to the Zygomatic Bone: A Case Report and Review of the Literature

PURPOSE

Extra-articular temporomandibular bony ankylosis between the zygomatic bone and coronoid process is a rare condition. Currently, there are fewer than 40 cases reported in the English-language literature. The aim of this study was to report a case of zygomatico-coronoid ankylosis with surgical intervention and a literature review.

MATERIALS AND METHODS

Through a PubMed search from 1946 to February 2018, using the terms ("extra-capsular" OR "zygomatico-coronoid" OR "extra-articular") AND ("ankylosis"), 61 articles were initially identified. After screening, manual reviewing, and including additional articles through reviews of the reference lists, 26 reports (33 patients) were included in the analysis.

RESULTS

Patients' age ranged from 12 to 71 years (mean, 36.62 yr; standard deviation, 16.24 yr). The gender composition of patients was male (n = 20; 60.6%), female (n = 12; 36.4%), and unknown (n = 1; 0.3%), with a clear male predominance. The etiologies were trauma (n = 25; 75.8%), infection (n = 3; 9.1%), surgical complication (n = 4; 12.1%), and radiotherapy for maxillary cancer (squamous cell carcinoma; n = 1; 3.0%). The treatment options were surgical intervention through an intraoral approach (n = 19; 57.6%), an extraoral approach (n = 10; 30.3%), and intraoral and extraoral approaches (n = 2; 6.1%) and nonsurgical intervention (n = 2; 6.1%).

CONCLUSION

Zygomatico-coronoid ankylosis is a possible cause of mouth-opening limitation, particularly in relation to facial trauma. However, it can be easily overlooked because of the rarity of zygomatico-coronoid ankylosis and the attention focused on the joint. Surgical intervention is regarded as a good treatment to improve mouth-opening limitation.

Two typical cases of pseudoankylosis of the jaw: same treatment, different outcome

Pseudoankylosis of the temporomandibular joint is a rare, extra-articular form of ankylosis of the jaw. It is characterised by limited mandibular movement caused by an extrinsic condition of the joint leading to fusion between the coronoid process and temporal, zygomatic or maxillary bone. Pseudoankylosis is less frequent than the intracapsular form. Extracapsular ankylosis can be congenital or acquired; approximately 70% of cases are associated with trauma. A CT scan is usually requested to achieve a diagnosis. CT can detect bony fusion, thus differentiating pseudoankylosis from true ankylosis. Once symptomatic bone ankylosis is diagnosed, surgery with postoperative physiotherapy is the recommended treatment. The ankylotic bone is removed together with the coronoid process and the mouth is forced open under general anaesthesia. Two cases of post-traumatic pseudoankylosis of the jaw treated with bilateral coronoidectomy and postoperative physiotherapy are described.

Extra-articular ankylosis after zygoma fracture; A case report & review of literature

Extra-articular temporomandibular bony ankylosis between the coronoid process and the zygoma is quite uncommon. In this paper we present a case of fusion of the left coronoid to the zygomatic bone in a 23-year-old male. This bony ankylosis was the result of five-week-old untreated zygomatic complex fracture. Ankylosis developed secondary to heterotopic bone formation following trauma. Zygomatico-coronoid ankylosis of the mandible is a complication which rarely occurs if fractures of the middle third of the facial skeleton have been adequately treated. The patient was treated by intraoral coronoidectomy. The rationale for clinical and radiographic diagnosis and treatment is reviewed.

Zygomaticocoronoid ankylosis: a rare clinical condition leading to limitation of mouth opening

Ankylosis, between the coronoid process and the zygoma, is a rare occurrence. A review of the literature has disclosed 15 reported cases of this disorder. True incidence of this condition might be even higher. Zygomaticocoronoid ankylosis might have been encountered by many surgeons, and yet it has been misdiagnosed or overlooked.In this article, the treatment of a 14-year-old patient with zygomaticocoronoid ankylosis is presented. With regard to treatment, there are various opinions as to whether the coronoidectomy be performed intraorally or extraorally. In this study, treatment of the patient has been performed via intraoral approach.

Treatment of zygomatic arch fracture with lag screws

Zygomatic arch fractures often occur as part of a zygoma fracture or Le Fort type III fractures of the maxillary. Isolated fractures of the zygomatic arch comprise around 10% of all zygoma fractures. The main etiologic factors are traffic accidents, falls, assaults, and sport accidents. Treatment may involve minimally invasive surgical procedures for slightly dislocated fractures or surgery with more extensive access for large dislocations of bone segments. This article reports the case of a 41-year-old male victim of physical aggression to the face with a steel sickle with an exposed, unstable fracture of the zygomatic arch. The patient underwent general anesthesia, and after the reduction of the fractures, the bone segments were fixed with 2.0-mm screws.

Transzygomatic coronoidectomy as a treatment for pseudoankylosis of the mandible after transtemporal surgery

Pseudoankylosis of the mandible after a transtemporal operation is rare. In patients with severely limited mouth opening, a transzygomatic approach is the approach of choice. We report a case of pseudoankylosis of the mandible that was successfully treated by transzygomatic coronoidectomy.

Anquilose temporomandibular bilateral: aspectos fonoaudiológicos e procedimentos clinidos

OBJETIVO: apresentar uma proposta terapêutica miofuncional orofacial, os procedimentos utilizados e resultados em caso de anquilose temporomandibular bilateral, buscando ressaltar a importância do trabalho interdisciplinar e a contribuição da fonoaudiologia para a reabilitação do sistema estomatognático nesses casos. MÉTODOS: relato de caso de paciente adulto, gênero masculino, encaminhado para avaliação e procedimentos fonoaudiológicos após três meses da realização de cirurgia articular, tendo como queixa principal grande restrição na abertura da boca. Na avaliação fonoaudiológica foi constatado: abertura da boca máxima em 25 mm, ausência de movimentos de lateralidade e de protrusiva, mordida aberta anterior em 8 mm, dor constante em região temporal, dificuldade para realizar mastigação, deglutição, articulação da fala. Constou dos objetivos terapêuticos: estimular e possibilitar a execução de movimentos mandibulares minimizando progressão de tecido cicatricial restritivo e reabilitação miofuncional. Procedimentos quanto ao aumento da amplitude através de relaxamentos, alongamentos, massagens, movimentos isotônicos, isométricos, isocinéticos e manobras específicas foram essenciais para estabilizar a abertura da boca, liberar os movimentos mandibulares e coordená-los, melhorando a funcionalidade do sistema estomatognático. RESULTADOS: após 24 sessões: ganho de 16 mm na abertura passando para 41 mm; redução da mordida aberta anterior para 4 mm, melhora da higiene oral, da articulação da fala, das condições alimentares com ganho de força mastigatória e redução dos mecanismos compensatórios; eliminação da dor em região temporal, além de melhora na estética facial. CONCLUSÃO: a terapêutica fonoaudiológica miofuncional orofacial mostrou-se eficiente em adulto com anquilose temporomandibular bilateral pós-cirúrgico, com estabilidade dos resultados mantida segundo controle anual.

Release of extra-articular ankylosis by coronoidectomy and insertion of a free abdominal flap: case report

INTRODUCTION

It is generally agreed that an effective treatment for extra-articular ankylosis may be coronoidectomy and excision of scar tissue. But these conventional procedures have shown a high rate of recurrence of ankylosis due to heterotopic bone and fibrous tissue formation. OBJECTIVE AND PATIENT: We report a case in whom a coronoid osteotomy and insertion of a free abdominal flap was used to treat ankylosis of the mandible following radiotherapy for maxillary cancer.

RESULTS

This procedure prevented recurrence of ankylosis by heterotopic bone and fibrous tissue formation. In addition, this flap reduced the risk of postoperative infection and promoted primary healing.

CONCLUSION

The procedure, coronoidectomy and insertion of a free flap, was successful because the well-vascularized musculocutaneous flap occupied the dead space, and replaced the shortage of oral mucosa consequently inhibiting the recurrence of extra-articular ankylosis.

Restricted opening of the mouth with an extra-articular cause in children

Restricted opening of the mouth with an extra-articular cause (ROMEC) can have very different aetiologies. A series of 6 children, who have been operated on under 4 different diagnoses, are presented. Excluded are common problems such as recent trauma and posttraumatic scarring, craniomandibular dysfunction or elongated coronoid process, and also tumours. Problems of establishing the diagnosis, surgical treatment, postoperative physiotherapy and timing are discussed. It is shown that none of the cases is a perfect result, some outcomes are even very disappointing. It is therefore concluded that absolute trismus should be treated independently of age. The result expected will be mediocre. For final correction it is suggested that the operator should wait preferably until the second growth spurt has passed. The same goes for children presenting primarily with a mouth opening greater than 20 mm.

Extra-articular ankylosis of the coronoid processes to the base of the skull. A case report

Extra-articular temporomandibular bony ankylosis between the coronoid process and the base of the skull is quite uncommon. In this paper we present a case of fusion of the right coronoid to the maxilla and sphenoid bone in an 18-year-old male. This bony ankylosis was the result of surgical removal of an odontogenic tumour from the right mandibular ramus when the patient was 4 years old. The ankylosis of the right coronoid resulted in hypoplasia of the mandible and fibrous fusion between the left coronoid and the base of the skull. The patient was treated by bilateral operation. Postoperative recurrent dislocation of the left condyle was attributed mainly to unbalanced muscle activity and to the flattening of the articular eminence of the left temporomandibular joint which had developed during the long duration of the ankylosis. This was successfully treated by left condylectomy.

Limited mandibular movement: causes and treatment

Limited mandibular movement is a challenging clinical problem. A variety of treatment modalities have been described to permit planning of an individual course of treatment for each patient.