[Modified Risdon approach for non-traumatic ramus surgery]

Revisiting the sub-mandibular approach with a modified incision

Angle of mandible has been long plagued throughout the history for being one of the most common places of facial bone fracture and also related complications if not treated properly. Hereby, two cases of fracture of angle of mandible those were surgically treated with an aim to modify existing extra-oral approaches specifically for treating the mandibular angle fractures for the purpose of open reduction and internal fixation so as to have a good access combined with an aesthetic and inconspicuous scar postoperatively are described. Also, an attempt is made to add one more type of incision to many existing ones so that future surgeons can choose over which best suits their procedure and as an addition to the ever-increasing literature. There is no doubt that meticulous surgical procedure and experience is needed to identify the structures, to stay in the plane of desire and work in comparatively bloodless field. Hence this approach can be bit challenging for newer surgeons. Nonetheless, the result after the closure of the field is quite rewarding.

[Transoral coronoidectomy: Technical note]

INTRODUCTION

Among the skeletal causes of limited mouth opening, uni- or bilateral coronoid process hypertrophy, or Langenbeck disease, is the most frequent. It can be associated with an osteochondroma or a coronoid-malar bone conflict and is then called Jacob disease, an unilateral pathology. Treatment rests on coronoidectomy in both cases. This technique is illustrated via two cases, one Langenbeck and one Jacob disease.

TECHNICAL NOTE

A transoral approach was performed. After subperiosteal dissection, the coronoid process was cleared. The process was than severed at its base by means of a burr, freed from its temporal muscular fibers and removed. Mouth opening improved peroperatively. The surgical procedure was completed by active long-term physiotherapy beginning immediately after surgery.

DISCUSSION

Transoral coronoidectomy is a simple, quick and safe procedure. Extra-oral approaches present a high risk of facial nerve injury. In our first case, mouth opening improved from 24 to 36 mm after bilateral coronoidectomy and to 40 mm after physiotherapy. In our second case, mouth opening improved from 22 to 38 mm after unilateral coronoidectomy and to 43 mm after one year physiotherapy. Long-term post-operative physiotherapy is mandatory to get and maintain good results.