CASE REPORTS   

Italian Journal of Maxillofacial Surgery 2011 April;22(1):61-4

Copyright © 2011 EDIZIONI MINERVA MEDICA

lingua: Inglese

Zygomatic-coronoid ankylosis after a six-month intermaxillary fixation: case report

Graziano P. ¹, Dell’Aversana Orabona G. ¹, Iaconetta G. ², Abbate V. ¹, Califano L. ¹

¹ Department of Maxillofacial Surgery, Federico II University, Naples, Italy; ² Department of Neurosurgery, Federico II University, Naples, Italy

The ankylosis of coronoid process and zigomatic arch is an extremely rare craniofacial pathology. It can be defined as a bony pathology in which the development of fibrous adhesion between coronoid process and zigomatic arch cause a reduction of the normal mandibular movements. A 18-year-old woman referred at our Department, presenting a progressive reduction of mandibular movements following a facial trauma occurred three years before. Initially she was treated, in another institution, by a intermaxillary fixation. For unknown reasons, after this treatment, she remained for six months without remove the fixation. It result in an important limitation in mouth opening (0.5 cm). An ortopantomography and a computed tomography scan of the temporal mandibular joing (TMJ) were performed and we observed an ankylotic process between right coronoid and zygomatic arch associated to an increase in size of the bones involved. The TMJ was free from disease. At surgery, performed through endoral approach, the ankylosis between zygomatic arch and coronoid process was removed. The result obtained was an increasing in the mouth opening of 2.2 cm. The final diagnosis was coronoid-zygomatic ankylosis due to the long time intermaxillary block. This gave rise to a metaplastic changes in connective tissue elements that do not have ordinarily an ostegenic potential. In our opinion it is a mistake to perform an intermaxillary block after traumas for so long time as our case; it is always recomandable a mobilization of the TMJ as soon as possible: in our experience two-three weeks.