Perichondritis as an Associated Complication Affecting the Surgical Outcome of Interpositional Arthroplasty: A Case Repo
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CASE REPORT
Perichondritis as an Associated Complication Affecting the Surgical Outcome of Interpositional Arthroplasty: A Case Report Punit S. Dikhit1,2 • Gaurav Jain3 • Pravesh Singh4 • Ankita Srivastava1
Received: 2 May 2019 / Accepted: 22 August 2019 Ó The Association of Oral and Maxillofacial Surgeons of India 2019
Perichondritis is a distressing complication of external ear leading to secondary deformity [1, 2]. Most common etiology stated for this condition is repeated trauma or penetrating injury to auricular cartilage [3]. It might also occur as a result of spread of infection from nearby foci [4]. The pinna has lesser soft tissue adherent to the underlying avascular cartilage, making it more vulnerable to necrosis [5]. Affected ear has been termed as ‘‘cauliflower ear’’ [6]. Perichondritis is most commonly seen following direct injury to auricle or chronic ear infection, uncommonly seen associated with TMJ surgeries. This condition adversely affects younger age group for whom it may be of concern due to cosmetic outcome [7]. The purpose of this paper is to highlight the possibility of such condition following interpositional arthroplasty of temporomandibular joint. It requires particular attention if encountered [5].
& Ankita Srivastava [email protected] Punit S. Dikhit [email protected] Gaurav Jain [email protected] Pravesh Singh [email protected] 1
Department of Dentistry, AIIMS, Bhubaneshwar, India
2
Kidwai Memorial Institute of Oncology, Bangalore, India
3
Department of Oral and Maxillofacial Surgery, AIIMS, Jodhpur, India
4
Rishi Hospital and Trauma Centre, Lucknow, India
Case Report A 22-year-old male patient was referred to maxillofacial surgery clinics with complaint of inability to open mouth since 19 months. Gradually, over the period of 11 months, his mouth opening reduced significantly and reached almost nil. Based on history, clinical examination and computed tomographic scans, diagnosis of post-traumatic right side TMJ ankylosis was made (Fig. 1). Patient was planned for gap arthroplasty followed by temporalis muscle interposition. Standard modified Al-Kayat Bramley incision was used for joint exposure. Planned surgery was carried out. Intra-op mouth opening of 39 mm was achieved. Postoperative physiotherapy was started and patient was discharged on the fourth post-op day. Patient reported back for follow-up after 1 week with mouth opening of 38 mm. After 2 weeks, patient again reported with reduced passive mouth opening of 32 mm and swelling on the external ear associated with pain (Fig. 2). Swelling was fluctuant, erythematous and tender. Patient has voluntarily restricted mouth opening due to pain, but active mouth opening was still 35 mm. Surgical wound site was healthy. Based on the above findings and ENT consultation, diagnosis of auricular perichondritis was made and planned for incision and drainage under antibiotic coverage. Cartilage destruction of around 0.5 cm was noted (Fig. 3). Culture and sensitivity reports revealed Pseudomonas species sens
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