Treatment of hyperplasia of the coronoid process of the mandible in adults: analysis of 42 literature reports and illustrative case

Abstract

Objective: The objective of this research was to review the literature, compare different methods of surgical treatment for coronoid hyperplasia and report a clinical case of unilateral coronoid hyperplasia treated by coronoidectomy with intraoral access. Methods: A critical review of the literature was performed by selection of papers published in the last 20 years on the treatment of coronoid in adults in the PubMed, Medline, Scielo and Lilacs databases, with the terms coronoid hyperplasia OR coronoid elongation AND treatment OR management. The data was extracted for analysis. Results: twenty-four articles were selected. It included 42 patients, among them 69% were male patients and 81% were bilaterally affected. The age group with the highest prevalence was the people in the 20's and 30's. Sixty-nine percent of the patients were treated with coronoidectomy and 26.2% with coronoidotomy. The majority (83.3%) with intraoral access. No cases had surgical complications reported, and 71.4% underwent physiotherapy after surgery. Regarding the results, 83.3% were considered satisfactory, 11.9% were unsatisfactory. Conclusion: The great majority of the cases that brought significant results in the improvement of the pre and postoperative mouth opening were treated by coronoidectomy, proving to be an efficient and safe surgical treatment for the coronoid hyperplasia.

Endoscopically Assisted Intraoral Coronoidectomy for Treatment of Coronoid Hyperplasia

“…Clinically patients with ECP refer to a progressive reduction in mouth opening, without temporomandibular joint pain, joint sounds, or acute lock 2,9,11 . Muscles of mastication are usually normal.…”

“…In our series, the preoperative maximal interincisal opening was 17.2 mm, which is similar to that published by Goh et al 2 in his bibliographic review of 115 cases (16.5 mm). The best diagnostic method to confirm the diagnosis of ECP is CT or cone-beam computed tomography, 2,9 in some selected cases magnetic resoance imaging should be obtained when internal derangements are suspected. Nayak et al 14 reviewed 160 dry human mandibles from an osteology bank and found that most of the specimens had a triangular-tip shape with a medium length of 15.3 mm in the right mandibular sides and 13.9 mm in the left sides studied.…”

“…Surgery (coronoidotomy or conoronoidectomy) is the only option to treat this condition 2,9,15 . A few authors performed coronoidotomy by leaving the coronoid segment in situ after osteotomy.…”

“…Hyperplasia of the coronoid process (HCP) was first reported by Von Langenbeck 7 in 1853, and Jacob, 8 in 1899, was the first author who described an osteochondroma of the coronoid process forming a pseudo arthrosis between the coronoid process and the zygomatic arch. Clinically, there is a progressive decrease in mouth opening, unilateral or bilateral, and painless 9 . The diagnosis of HCP is not usually considered at the first visit of patients with complaints of mouth opening restrictions.…”

“…The main aim of treatment is to restore the mouth opening, in a stable manner. Most authors agree on intraoral coronoidectomy as the treatment of choice 2,9 . However, in many cases, the small surgical field can make the osteotomy procedure, so endoscopic assistance may be useful in facilitating the surgical procedure and reducing postoperative complications 2,10 .…”