Bilateral coronoid hyperplasia causing painless limitation of mandibular movement

The coronoid process is a beaklike process in the ramus of the mandible. Coronoid process hyperplasia (CPH) is a rare possible cause of reduced mouth opening. An overgrown process interferes with mandibular rotation and lateral excursion and hence leads to restricted mouth opening (RMO). Although some factors are suggested, etiology of CPH is not completely known. Prescription of suitable radiography is necessary for an accurate diagnosis. This article reports a 30-year-old man with bilateral CPH and progressive RMO since childhood. This disorder affected his oral hygiene and quality of life. With the help of different types of radiography, CPH was diagnosed and coronoidectomy was the only treatment option. The patient showed normal jaw movements after the surgery and postoperative physiotherapy. General dentists have an important role in noticing RMO and referring the patients to maxillofacial radiologists. Although it is a rare phenomenon, general dentists need to keep CPH in mind as a possible cause. Panoramic imaging accompanied by computed tomography or cone beam computed tomography is the best imaging option in such cases.

Modification of existed prosthesis into a flexible wall hollow bulb obturator by permanent silicone soft liner for a hemimaxillectomy patient with restricted mouth opening

PATIENT

A patient of hemimaxillectomy with restricted mouth opening, wearing a hard acrylic bulb obturator encountered difficulty in insertion and removal of the prosthesis. The prosthesis was converted into a open hollow bulb obturator with flexible walls with permanent silicone soft liner for easy insertion and removal.

DISCUSSION

Patients having acquired maxillary defects due to surgical resection of the maxilla often suffer with difficulty in mastication, swallowing, nasal regurgitation, speech disturbances and poor esthetics. Different types of obturator with various bulb designs most commonly fabricated from acrylic resins together with "acrylic resin plate and/or" metal framework are used to improve the quality of life of these patients by restoring the function. But restricted mouth opening in some of these patients makes it difficult to place and remove the prosthesis with hard acrylic bulb. Fabrication of flexible open hollow bulb and relining of remaining obturator with resilient permanent silicone soft liner makes easy insertion and removal of the prosthesis and also improve the retention by intimate contact of soft liner with the tissues.

CONCLUSION

Permanent silicone soft liner open hollow bulb obturator is a novel way for the functional rehabilitation of a hemimaxillectomy patient suffering with restricted mouth opening.

Rehabilitation of hemimaxillectomy with foldable obturator in restricted mouth opening: a case report

Acquired defects of the head and neck region as in case of hemimaxillectomy can be devastating to the patients and presents considerable reconstructive challenge for the Prosthodontists. The defects created by the surgery results in damaging effects on functional, cosmetic, and psychological aspects of the patient. The purpose of this clinical report is to discuss the method of fabricating a foldable obturator for rehabilitation of a patient of hemimaxillectomy with restricted mouth opening.

Imaging features of mucopolysaccharidoses in the head and neck

Ear, Nose and Throat (ENT) involvement by mucopolysaccharidoses is very common, affecting over 90% of patients, and occurs early in the course of the disease. Airway narrowing secondary to glycosaminoglycan deposition results in greatly increased morbidity, mortality and risk of anesthetic complications in these patients. Macroglossia, restricted mouth opening, tracheobronchomalacia, adenotonsillar hypertrophy along with other factors such as a short, rigid and unstable cervical spine, cardiac disease and increased susceptibility to respiratory infections result in a high perioperative mortality and morbidity. Imaging is most beneficial for evaluation of the airway, in particular in patients with obstructive symptoms and prior to intubation. We review the ENT manifestations of mucopolysaccharidoses including airway involvement, otological, oral and dental complications. 3-D reconstructions of the trachea, which is routinely captured on CT imaging of the spine, can be of great value for planning intubation in this patient population.

Thioctic acid in oral submucous fibrosis (India's disease) - A better tomorrow

Oral submucous fibrosis (OSMF), because of its common occurrence in Indian population is known as India's disease. Regardless of diagnostic and therapeutic developments, oral potentially malignant disorders (PMD) and cancers are disseminating at a distressing rate. There is this prerequisite for unrelenting determination to find out apt treatment options so that malignant transformation may be prevented and more so the prevailing morbidity and mortality. Considering the frequency with which oral submucous fibrosis undergoes malignant transformation with free radicals playing a major part, the role of antioxidants in general and thioctic acid also known as alpha lipoic acid (ALA) in particular need to be studied in these individuals. Previous few studies indicated the use of alpha lipoic acid in oral submucous fibrosis patients leading to improvement in signs and symptoms. So, it led us to set forth and propose probable role of thioctic acid in improving symptoms in these patients. As oral submucous fibrosis poses as a threat with its various signs and symptoms and as a potentially malignant disorder as well as considering the role of free radicals in malignant transformation, we proposed the possible mechanisms behind the commonest signs and symptoms in oral submucous fibrosis and role of alpha lipoic acid in managing these signs and symptoms.

Evaluation of Joint Formation in Coronoid Process Hyperplasia (Jacob's Disease) on CT and MR Imaging

Background

Jacob's disease is a rare pathology characterized by elongation/ enlargement of coronoid process of mandible with formation of pseudoarticulation with zygomatic arch. It presents clinically as restricted mouth opening and is often misdiagnosed as temporomandibular joint pathology.

Case Presentation

We performed cross sectional imaging and evaluation of Jacob's disease in a 14-year-old girl with restricted mouth opening, CT images including Multiplanar Reconstruction and Volume Rendered Technique revealed enlarged left coronoid process of mandible while open mouth CT images and MR images concluded the presence of joint between enlarged coronoid process and zygomatic arch.

Conclusions

Coronoid process hypertrophy and Jacob's disease are important differentials which should be considered in evaluation of restricted mouth opening. We propose that apart from CT, MR imaging should be considered in such cases for better pre-operative evaluation of joint formation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03323-7.