A Case of Myomectomy with Temporomandibular Arthroplasty and Resection Case for 10 Years after Facial Multiple Fracture Injury

Abstract

We present a case of temporomandibular ankylosis with temporomandibular articulation, myomectomy, and functional improvement. A 59-year-old man, referred to our clinic, presented with low occlusion, eating disorder, and dysarthria. At the age of 48 years, he had sustained a fall from the fourth-floor balcony of his house and was diagnosed with bilateral temporomandibular fractures at another hospital. The bilateral temporomandibular fractures were treated with conservative therapy, followed by mouth-opening exercises. Immediately after discharge, mouth opening of approximately 30mm was noted, but decreased gradually over approximately 10 years since the referral. Computed tomographic images showed joint intraluminal adhesions, diagnosed as bilateral temporomandibular ankyloses, for which temporomandibular joint mobilization surgery was performed under general anesthesia. The bilateral mandibular head was resected and processus muscularis on both sides were excised, resulting in maximum intraoperative mouth-opening. Subsequently, the entire temporal fascia membrane was incised from a fascia valve, which was inserted and fixed into the bilateral maxillary resected tip. Postoperatively, the mouth-opening exercises were continued and occlusion was established with prosthetic treatment. Mouth-opening of 37 mm has been sustained for one year postoperatively without problem.