Fate of the Coronoid Process following Coronoidotomy and its Effect on the Inter-Incisal Opening– A Clinical and Radiological Assessment

Publication date: Available online 20 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Sujata Mohanty, Sanchaita Kohli, Jitender Dabas, Rudra Deo Kumar, Ranjeet Bodh, Sandeep Yadav
PurposeCoronoidotomy is used to treat several conditions, including coronoid hyperplasia and TMJ ankylosis. The stability of the outcome is, however, considered questionable due to risk of reattachment of the coronoid process. The current study aims to radiographically and clinically evaluate the long-term anatomical and physiological outcome following coronoidotomy.Methods25 coronoidotomies were performed as an additional maneuver to relieve trismus in 17 unilateral TMJ ankylosis patients following ankylosis release. Radiological evaluation was done immediately and 1 year post-operatively using OPG and CT to assess changes at the coronoidotomy site. Clinical assessment included measuring the inter-incisal distance at 1, 3, 6 and 12 month post-operative visits.ResultsA sharp osteotomy margin with a 3-10 mm gap between the ramus and coronoid process was observed immediately post-operatively in all cases. After one year, 23 cases (92%) showed partial (n=5) or complete (n=18) osseous union to the mandibular ramus, while in 2 cases, no evidence of fusion was observed radiographically. Mean inter-incisal opening achieved at one year was 33 mm.ConclusionCoronoidotomy, is an effective, but more straightforward adjunct to arthroplasty than coronoidectomy in management of TMJ ankylosis, with achievement and maintenance of adequate post-operative mouth opening.



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