2009 Volume 21 Issue 1 Pages 24-27
We encountered a rare case of severe trismus caused by bilateral coronoid hyperplasia, and were able to improve the symptoms by surgical coronoidectomy simulated using three-dimensional models.
The patient was a 43-year-old female who presented with a chief complaint of limited mouth opening. The patient had been aware of trismus since childhood. At 32 years old, she received routine therapy under a diagnosis of temporomandibular joint disease. However, her symptoms did not improve, and subsequently she consulted our faculty. Interincisal opening of the patient was limited to 13 mm. Panoramic radiography and three-dimensional computed tomography (3D-CT) demonstrated that both coronoid processes extended above the zygomatic arch, indicating a bilateral enlargement of the coronoid processes. Before surgical treatment we performed a simulation of the operation using models made from the 3D-CT data. Because of severe trismus, we simulated an operation using three-dimensional models from the 3D-CT data. Bilateral coronoidectomy was performed through an intraoral approach under general anesthesia. Following mouth-opening training, the patient has maintained an interincisal opening of 40 mm 1 year postoperatively.
