Transzygomatic coronoidectomy through an extended coronal incision for treatment of trismus due to an osteochondroma of the coronoid process of the mandible

Precise Coronoidectomy and Zygomatic Arch Reduction for Unilateral Hyperplasia of the Coronoid Process (Jacob's Disease) via Computer-aided Design and Manufacture

Jacob disease is the new formation of a pseudo-joint between both of enlarged coronoid process and even zygomatic arch. A 23-year-old female patient with facial asymmetry and limited mouth opening was reported. Computed tomography images showed the classic symptom of Jacob disease with a mushroom-shaped tumor mass from the coronoid process a pseudoarthrosis joint with zygomatic arch. Coronoidectomy and zygomatic arch reduction were planned to operate based on computer-aided design/computer-aided manufacturing. During the actual operation, the excision of coronoid process and reconstruction of zygomatic arch were all navigated by 3-dimensional-printed surgical templates as designed through an intraoral approach. As a result, the enlarged coronoid process was smoothly removed without sequela and mouth opening along with facial symmetry were successfully improved. The authors suggested that computer-aided design/computer-aided manufacturing should be considered as an auxiliary technique to shorten operation time and enhance surgical accuracy.

Jacob's Disease: Case Series, Extensive Literature Review and Classification Proposal

Jacob's disease is a rare entity consisting of the formation of a pseudojoint between an abnormal coronoid process of the mandible and the inner surface of the zygomatic bone. First described by Jacob in 1899, its diagnosis and definition have never been entirely univocal. In this paper, we present three emblematic cases and an extensive review of the literature on Jacob's disease. Given the variability observed in the presentation of the disease, we have developed a proposal for the classification, here reported.

Benign bony tumors of the paranasal sinuses, orbit, and skull base

Benign bony tumors of the skull base and paranasal sinuses are uncommon entities, with an overall higher incidence in males. Benign bony tumors may lead to local expansion with resultant mass effect of potentially critical structures. Some benign bony tumors may undergo malignant transformation. This article reviews the presentation and management of benign bone tumors of the skull base and paranasal sinuses with special consideration to involvement of the adjacent orbit, intracranial and critical neurovascular structures. This review covers tumor incidence, location, gross and histologic appearance as well as radiographic findings, treatment, and recurrence rates. Tumors discussed in this article include osteochondromas, osteomas, osteoid osteomas, aneurysmal bone cysts, fibrous dysplasia, giant cell tumors, cemento-ossifying fibroma, ameloblastic fibro-odontoma, ecchordosis physaliphora, chondromyxoid fibroma, primary chronic osteomyelitis, primary chronic osteomyelitis, osteochondromyxoma, and dense bone islands.

A Novel Approach to Coronoidectomy: the Modified Keen Technique

INTRODUCTION

Coronoid fractures are relatively rare fractures of the craniofacial skeleton, but typically occur concomitantly with high-velocity craniofacial trauma to the midface and lateral mandible. Management of coronoid fractures may vary, but when surgical excision is indicated, treatment frequently involves an intraoral approach through a posterior intraoral incision along the mandibular ramus. Here, the authors present an alternative and novel approach to the coronoid process based on the Keen approach to the lateral midface.

TECHNICAL NOTE

The authors present a patient with a left zygomatico-maxillary complex fracture and left coronoid fracture. After disimpaction of the zygomatico-maxillary complex fracture, a maxillary vestibular incision in the gingivobuccal sulcus was made. After subperiosteal dissection, the maxillary fracture was exposed and fixated. A modified Keen approach was used to expose the coronoid process, perform temporalis myotomy, and excise the fracture fragment.

DISCUSSION

Compared to the classic intraoral approach to coronoidectomy, the modified Keen approach is a quick, versatile technique that allows for direct visualization of the coronoid process without the use of endoscopy, facilitates fixation of concurrent midfacial fractures, and utilizes an anterior intraoral incision that is easy to retract and close. For these reasons, the modified Keen technique for coronoidectomy should be considered in the treatment of trismus when an intraoral approach is indicated.

Osteochondroma of the coronoid process: A case report and review of the literature

Osteochondroma (OC) is considered the most common tumor of the axial skeleton, although it is relatively uncommon in the craniofacial region. The present study describes an atypical case of OC of the coronoid process. A 34-year-old woman presented with severely limited mouth opening (5 mm) and swelling of the right zygoma. Cone-beam computed tomography (CBCT) revealed a mushroom-shaped outgrowth from the coronoid process to the inner surface of the zygomatic arch, forming a pseudojoint. The patient was treated with coronoidectomy via an intraoral approach. Histopathological examination revealed features suggestive of OC. Subsequently, the patient was able to open their mouth, and there was no evidence of recurrence or post-operative complications in the 21-month follow-up. A review of the literature revealed only 38 histologically proven cases of coronoid OC in the past 30 years (1989-2018). The incidence of the disease was higher in men compared with that in women (male:female, 2.17:1), and the median age at onset was 28.7 years, with a range of 5-57 years. Gradual limitation of mouth opening and facial asymmetry are the most noticeable symptoms. Water's view and submentovertex projection of the zygomatic arch may be useful in identifying the tumor and its association with the zygoma, while CT and CBCT permit a detailed visualization of the location and density of the tumor. Coronoidectomy is the preferred treatment option, and the prognosis is excellent, with no evidence of recurrence or malignant transformation.

One-stage treatment to osteochondroma of the coronoid process and secondary facial asymmetry with coronoidectomy and reduction malarplasty: a case report and literature review

PURPOSE

This study summarizes the literature concerning osteochondroma of the mandibular coronoid process and presents a case of 1-stage treatment for this condition and concomitant facial asymmetry.

MATERIALS AND METHODS

A 20-year-old man presented with osteochondroma of the mandibular coronoid process. Radiologic images showed a mushroom-shaped coronoid growth inside the zygomatic arch with outward expansion. Coronoidectomy and reduction malarplasty were performed in 1 stage. The literature on osteochondroma of the mandibular coronoid process since 1943 was reviewed concerning etiology, pathogenesis, clinical characteristics, diagnosis, and treatment.

RESULTS

At 20-month follow-up, the patient achieved markedly improved joint function and a symmetric facial appearance after excision of the osteochondroma.

CONCLUSION

Coronoidectomy combined with simultaneous reduction malarplasty could be an alternative and promising method to treat osteochondroma of the coronoid process with secondary facial asymmetry.

Limitation of mouth opening caused by osteochondroma of the coronoid process

BACKGROUND

Osteochondroma at the level of the coronoid process is unusual, causing a slowly progressive facial asymmetry and limitation of mouth opening. Histologically, it is a bone tumor covered by a thin capsule of cartilage. We present a literature review of cases published to date and present a new case in which osteochondroma originating in the coronoid process was associated with the formation of a cyst at the body of the zygoma, necessitating the reconstruction of the body of the zygoma.

STUDY DESIGN

A 55-year-old woman had a bone tumor in the right malar region, producing a limitation in mouth opening. After preoperative computerized tomography, we decided to excise the lesion and pseudocyst with the use of a combined subciliary and coronal approach, reconstructing the body of the zygoma with a cortical chip of calvarian bone.

RESULTS

The patient regained normal mouth opening, without injury to the fronto-orbital branches of the facial nerve and no recurrence of the tumor to date.

CONCLUSIONS

Osteochondroma is a slow-growing tumor that causes progressive facial asymmetry and limitation of mouth opening. The treatment of choice for symptomatic osteochondromas is surgical resection.

Jacob's disease: report of a rare case and literature review

Jacob's disease is a rare condition consisting of pseudojoint formation between enlarged coronoid process and the inner surface of the zygoma. The authors report a 45-year-old female patient who presented with limited mouth opening (5 mm) and swelling of the left zygoma. No temporomandibular joint disease was diagnosed. 3D computed tomography images showed a mushroom-shaped coronoid growth with pseudojoint formation medial and superior to the zygomatic arch. Under general anaesthesia, coronoidectomy was carried out through a combined extraoral and intraoral approach. Histopathological examination revealed normal trabecular bone covered with hyaline cartilage. To the best of the authors' knowledge this case is the fifth typical mushroom-shaped Jacob's disease; only four similar cases have been reported. A review of the literature revealed only 39 histologically proved cases of Jacob's disease cases up to 2010. Aggressive physical treatment was given to improve function and maximum mouth opening, which had increased to 40 mm at 3 months follow-up. The literature concerning this condition's aetiology, pathogenesis, clinical characteristics, diagnosis, and treatment is reviewed.

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.