Abstract
We encountered a patient with marked mouth-opening disturbance, whose cause was considered to be chronic inflammation of the pterygoid muscle due to pericoronitis of a maxillary wisdom tooth. The patient was a 69-year-old male, who noticed mouth-opening disturbance approximately 5 years ago, and had received mouth-opening training after being diagnosed with temporomandibular joint ankylosis 2 years ago at the Department of Oral Surgery in a general hospital. However, because there had been no improvement of symptoms, the patient was referred to our department. At the first examination, the maximum mouth-opening distance was 5 mm, and forced mouth-opening distance was 6 mm, showing marked disturbance. X-ray images showed a normal morphology of the condyle. However, CT and MRI confirmed inflammatory changes in the medial and lateral pterygoid muscles. From these findings, the cause of mouth-opening disturbance was diagnosed as chronic inflammation of the pterygoid muscle due to the spread of pericoronitis of the left maxillary wisdom tooth. After extracting the wisdom tooth, reducing the inflammation using antibacterial agents, the maximum mouth-opening distance recovered to 35 mm. One year and 6 months have passed since surgery and the improved mouth-opening distance has been maintained, showing a favorable clinical course. From these results, it was considered that, in cases of marked mouth-opening disturbance without acute inflammation, examination considering not only the temporomandibular joint disorders, but also the possibility of a tumor or chronic changes in the head and neck regions is necessary.
