Extra-articular ankylosis after zygoma fracture; A case report & review of literature

Treatment of Posttraumatic Zygomatic Coronoid Ankylosis. Systematic Review

Facial trauma is mostly associated with traffic accidents, fights, and sports accidents. The mandible, midface, and temporomandibular joint are usually the region's most frequently affected. Coronoid process fractures are rare, representing ∼2% of facial fractures in the literature, usually being the result of direct trauma to the zygomatic region. Due to the anatomical relationship of the coronoid process, it may be associated with other facial fractures, such as fractures of the zygomatic bone. Zygomatic-coronoid ankylosis is a rare clinical entity with variable etiology. It is most commonly associated with trauma (13%-100%), local or systemic infection (0%-53%), or systemic diseases, such as ankylosing spondylitis, rheumatoid arthritis, or psoriasis. The aim of this research is to evaluate the different treatments for ankylosis from the coronoid process to the zygoma after trauma, allowing to determine the treatment to obtain the best results. A systematic review was carried out following PRISMA "preferred reports for systematic reviews and meta-analyses" search matrix, based on a PICO question; was used PubMed, Embase, Sciencedirect, Cochrane, Google Scholar, and manual search in high-impact journals between 1946 and 2023 publications in English or Spanish, including randomized and nonrandomized clinical trials, prospective and retrospective cohort studies, case-control studies, series, and case reports. A total of 1993 articles were obtained from the 4 databases. After corroborating duplicate articles, 847 articles were excluded. Another 1112 articles were excluded in the title evaluation, and an additional 1093 after the abstract review; a total of 19 articles eligible for full-text evaluation were established and 1 article was added as a result of the manual search. After the full-text review, it was decided to include 16 articles in the study that met the objectives of the systematic review. After evaluating the different treatments described in the literature, the authors can determine that coronoidectomy through an intraoral approach is the most appropriate treatment for zygomatic coronoid ankylosis, accompanied by postoperative physiotherapy to achieve greater oral opening without recurrences.

Zygomaticocoronoid ankylosis with possible myositis ossificans: a very rare case

Ankylosis forming between the zygomatic arch and the coronoid process is a rarely encountered pathological extracapsular ankylosis. Its treatment protocol consists of surgical removal of the coronoid process with the ankylotic mass and jaw opening-closing exercises after surgery. Myositis ossificans (MO) is a self-limiting, benign ossifying lesion. It affects all types of soft tissues including subcutaneous adipose tissue, muscles, tendons and nerves. It is most frequently found in the muscle as a solitary lesion. The clinical appearance of MO is generally in the form of a mass characterized with an ossified soft tissue. When it develops alone, cross-sectional imaging might not be specific, and it may appear similar to worse etiologies. It is suggested multiple imaging modalities should be used in the assessment of a suspicious soft tissue mass. MO is a benign self-limiting disease. In this case report, in the radiographic examination of a 41-year-old female patient, ankylosis between the left coronoid process and the zygomatic bone accompanied by possible MO in the left medial pterygoid muscle was observed. Resection of the coronoid process with the ipsilateral route, resection of the ankylotic mass with the hemicoronal approach and resection of the contralateral coronoid process with the intraoral approach were performed, but the ossified formation in the medial pterygoid muscle was not touched.

Strategy for the Treatment of Zygomatic-Coronoid Ankylosis

Zygomatic-coronoid ankylosis is a rare complication in maxillofacial trauma. Currently, less of 30 cases reported in the literature. The aim of this study was to report a case of zygomatic-coronoid ankylosis after trauma. A 26-year-old male, with zygomatic-coronoid ankylosis after 7 years of facial trauma, was treated by intraoral bilateral coronoidectomy. However, the literature continues to discuss the best approach, intraorally or extraorally. This study observed that the intraoral approach was easily performed and without complications.

Extensive temporomandibular joint ankylosis involving medial pterygoid plates and the maxillary tuberosity- a case report

Background

Temporomandibular joint ankylosis is a distressing condition which leads to significant functional debility and facial blemish. It can be surgically managed with gap or interposition arthroplasty, with an objective to restore joint function and prevent re-ankylosis. Sometimes TMJ ankylosis can present with atypical presentations like skull base ankylosis. The main aim of this surgery is to successfully treat such conditions efficiently without any possible complications. However, surgical procedures for such atypical presentations in this disease are rarely reported.

Case summary

Here we report a 27 year old male with Left TMJ ankylosis involving the skull base. The patient presented with reduced mouth opening with a previous history of trauma. For treatment we performed a surgery by doing osteoarthrectomy with interpositional arthroplasty of left TMJ using piezosurgery. To our knowledge this is the only TMJ ankylosis case with involvement of bones of the skull base treated with piezosurgery. Intraoperatively we achieved a mouth opening of 30 mm, and postoperatively after 15 days mouth opening up to 30 mm was achived with physiotherapy.

Conclusion

Some times TMJ ankylosis can present with atypical presentations in which bones of the skull base are involved. These are very rare and could be termed as 'skull base ankylosis'. Such cases can be surgically challenging and some surgical treatment modalities like Computer Assisted Surgery (CAS), 3D Navigation and Piezo-electric surgery could be beneficial in avoiding complications and facilitating efficient treatment.

Ankylosis of the Coronoid Process to the Zygomatic Bone: A Case Report and Review of the Literature

PURPOSE

Extra-articular temporomandibular bony ankylosis between the zygomatic bone and coronoid process is a rare condition. Currently, there are fewer than 40 cases reported in the English-language literature. The aim of this study was to report a case of zygomatico-coronoid ankylosis with surgical intervention and a literature review.

MATERIALS AND METHODS

Through a PubMed search from 1946 to February 2018, using the terms ("extra-capsular" OR "zygomatico-coronoid" OR "extra-articular") AND ("ankylosis"), 61 articles were initially identified. After screening, manual reviewing, and including additional articles through reviews of the reference lists, 26 reports (33 patients) were included in the analysis.

RESULTS

Patients' age ranged from 12 to 71 years (mean, 36.62 yr; standard deviation, 16.24 yr). The gender composition of patients was male (n = 20; 60.6%), female (n = 12; 36.4%), and unknown (n = 1; 0.3%), with a clear male predominance. The etiologies were trauma (n = 25; 75.8%), infection (n = 3; 9.1%), surgical complication (n = 4; 12.1%), and radiotherapy for maxillary cancer (squamous cell carcinoma; n = 1; 3.0%). The treatment options were surgical intervention through an intraoral approach (n = 19; 57.6%), an extraoral approach (n = 10; 30.3%), and intraoral and extraoral approaches (n = 2; 6.1%) and nonsurgical intervention (n = 2; 6.1%).

CONCLUSION

Zygomatico-coronoid ankylosis is a possible cause of mouth-opening limitation, particularly in relation to facial trauma. However, it can be easily overlooked because of the rarity of zygomatico-coronoid ankylosis and the attention focused on the joint. Surgical intervention is regarded as a good treatment to improve mouth-opening limitation.

Delayed diagnosis in the maxillofacial region: Two case reports

While conventional CT scan has historically been used for maxillofacial bone imaging. The introduction of cone beam CT (CBCT) in the new millennium has revolutionized the use of CT for dental and maxillofacial diagnoses. This paper presents two clinical examples of delayed diagnoses associated with maxillofacial imaging, describes the reasons for the delays and offers potential preventive measures. The first case involves a delay in the diagnosis of non-Hodgkin's lymphoma in a 49-year-old female who was being treated for an odontogenic problem. In the second case, a 9-year-old female who presented with a limited ability to open her mouth was mistakenly diagnosed with muscles spasm. Subsequently, she was found to have an elongation of the right lateral pterygoid plate that interfered with her right mandibular body, which restricted the degree to which she could open her mouth. A thorough clinical examination and accurate radiographic interpretation combined with a complete medical history can minimize these types of diagnostic delays. If the dentist is unable to conclusively reach a diagnosis, the patient should be referred immediately to a specialist who can better manage the specific medical problem.