Fracture of the Coronoid Process Associated with Frontosphenoidal Fractures

Abstract

Fracture of the coronoid process is rare and account for only 0.6 to 4.7% of all facial fractures. 1 They are usually simple and linear fractures with minimal displacement, since the fragment is splinted by the tendinous insertion of the temporalis muscle. But in cases of complex trauma, the bone might be displaced into the temporal fossa. 2 Natvig et al 3 classified coronoid process fractures into two types:1. Intramuscular: where the fracture fragment is within the investing fascial attachment of the temporalis muscle. 2. Submuscular: where the fracture is below the musculotendinous attachment. In these cases, there may be superior and medial displacement of the fragment.The zygomatic complex shields the coronoid process; hence, an isolated coronoid fracture is rarely seen in the absence of an arch fracture. 1 Case Reports Case 1A 40-year-old male patient presented to our trauma center following a road traffic accident. Patient was referred to a neurosurgeon as he had frontosphenoidal trauma. He was managed conservatively by the neurosurgeon for the same.As the patient also had facial injuries and difficulty in opening the mouth, he was referred to us. The computed tomography (CT) scan, apart from the fractures of the cranial bones, revealed a right zygomaticomaxillary complex (ZMC) fracture along with right coronoid, nasal bone, and an incomplete Le fort I fracture (►Fig. 1).All the facial bone fractures, apart from the right coronoid fracture, were managed with open reduction and internal fixation with mini plates. Case 2A 33-year-old male patient presented to our trauma center following a road traffic accident. Patient was referred to a neurosurgeon for the management of head injury. He was managed conservatively by the neurosurgeon.The CT scan revealed frontosphenoidal fractures along with a left ZMC and left coronoid fracture (►Fig. 2).Patient was managed with open reduction and internal fixation for the ZMC fracture and the coronoid process fracture was managed conservatively.As both our patients had intramuscular coronoid fractures, they were managed conservatively for the same. They recovered uneventfully, and were asymptomatic postoperatively with no difficulty in mouth opening and lateral excursions of the mandible. DiscussionFractures of the coronoid process are often not evident clinically. Many such injuries go undiagnosed 4 because it is difficult to radiologically diagnose these fractures with Keywords ► coronoid process fractures ► frontosphenoidal injury ► treatment options AbstractCoronoid process fractures are rarely encountered, commonly undiagnosed, usually asymptomatic, and most commonly treated conservatively, hence very little written about. We present two cases of coronoid process fractures with associated frontosphenoidal injuries.