Unilateral coronoid hyperplasia treated by coronoidectomy using a transzygomatic approach
A 15-year-old male with no medical history of interest reported to the out-patient department of Government College of Dentistry, Indore, with the chief complaint of facial asymmetry [].\nThe patient mentioned asymptomatic difficulty in opening his mouth. On examination, he was found to have a reduced mouth opening, with limited lateral and protrusive jaw movements and no hypertrophy of the masseter muscles [].\nA CT scan was carried out with three-dimensional reconstruction (3D CT), showing unilateral hyperplasia of the coronoid process and contact between said process and the zygomatic arch, limiting mouth opening- movement [Figures and ].\nDue to massive anteroposterior extent of coronoid, transzygomatic approach was considered.[] A hemicoronal incision ending in a preauricular extension up to the lobule of the ear was made through the skin, subcutaneous tissue, and galea. In the temporal region, this incision was up to superficial layer of the temporal fascia. At the root of the zygomatic arch, the superficial layer of temporalis fascia was incised anterosuperiorly at a 45° angle. The periosteum was incised to expose the zygomatic arch [].\nTwo plates were adapted, bridging the osteotomy site on the zygomatic arch. The arch was osteotomized, temporalis muscle was stripped off the coronoid, and the process exposed adequately. An osteotomy cut was taken on the coronoid and the enlarged coronoid stump was removed [].\nZygomatic arch was repositioned in its proper anatomic position and fixation was performed with titanium plates [].\nThe wound was then closed in layers. Postoperative healing was uneventful. The patient reported after 6 months with adequate mouth opening and marked reduction in facial asymmetry [Figures and ].