Difficulty of Arch Reduction with Gillies Temporal Approach in a Coronoid Hyperplasia Case
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TECHNICAL NOTE
Difficulty of Arch Reduction with Gillies Temporal Approach in a Coronoid Hyperplasia Case Sreea Roy1 • Adarsh Kudva1 Shalini Agarwal1
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Smriti Puri1 • Mridula Sankaran1
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Received: 20 August 2020 / Accepted: 14 October 2020 Ó The Association of Oral and Maxillofacial Surgeons of India 2020
Abstract Introduction Bilateral coronoid hyperplasia is an abnormal elongation of the mandibular coronoid process which is rare in occurrence and causes progressive but slow reduction in mouth opening. In case of reduction in zygomatic arch fracture by Gillies temporal approach, the presence of bilateral coronoid hyperplasia can be a possible factor for hindrance and improper reduction. Material and methods We propose a technical note to overcome this hindrance caused by the coronoid hyperplasia and propose tips and tricks to successful reduction in zygomatic arch. Results Adequate reduction in the zygomatic arch and pretrauma mouth opening was achieved. Conclusion Manual repositioning of the mandible during Gillies temporal approach along with ultrasound guidance leads to a satisfactory outcome. Keywords Coronoid Hyperplasia Zygomatic Arch Gilles Temporal Approach
& Adarsh Kudva [email protected]; [email protected] Sreea Roy [email protected]; [email protected]; [email protected] Smriti Puri [email protected] Mridula Sankaran [email protected] Shalini Agarwal [email protected] 1
Department of Oral and Maxillofacial Surgery, MCODS, Mahe Manipal, Manipal, India
Coronoid hyperplasia was first described by Langenbeck in the year 1853 [1]. Mandibular coronoid process hyperplasia (CPH) is rare in occurrence and causes progressive but slow reduction of mouth opening [2]. It is defined as an abnormal elongation of the mandibular coronoid process consisting of histologically normal bone [2]. This causes impingement of the coronoid process on the body or arch of the zygomatic bone during mouth opening. Movements of hyperplastic coronoid process interfere with the medial or temporal surface of the zygomatic bone. With the progressive growth of the coronoid process the infratemporal space needed for rotation and translation of mandible is reduced that in turn reduces the ranges of mouth opening [3, 4]. The etiology of CPH is not completely clear. However, several factors have been attributed to temporalis muscle hyperactivity, trauma, hormonal factors, genetics, and familial factors [3]. A 32-year-old patient reported 4 days after a history of an alleged road traffic accident with reduced mouth opening of only 6 mm. Patient reported that prior to accident he used to open his mouth wide approximately three fingers breadth. Radiological investigation revealed isolated leftside zygomatic arch fracture with the bilateral elongated coronoid process. He was scheduled for a closed reduction of the arch by Gillies temporal approach under general anesthesia. A Rowe’s modification of Bristow’s elevator was placed between the superficial layer of deep temporal fascia and temporalis mu
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