Severe limitation in mouth opening following transtemporal neurosurgical procedures: diagnosis, treatment, and prevention

Abstract

Five new patients and six previously described patients with severe limitation in maximum mouth opening following transtemporal neurosurgical procedures are described. Six patients underwent an operation for epidural hematoma and three for skull-base meningloma; two were treated with a pterional craniotomy for an aneurysm. Limited maximum mouth opening in these circumstances is caused by temporal muscle scarring and shortening. Aggressive physiotherapy is potentially beneficial if started early. If, however, diagnosis is delayed, the efficacy of physiotherapy declines, and surgical treatments such as temporal muscle detachment and coronoidectomy are fully indicated. The differential diagnosis, prevention, and treatment of limited maximum mouth opening following neurosurgical procedures are discussed.

A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis

“…However, use of the temporalis muscle as interpositional tissue may limit mouth opening by scarring of the temporalis muscle with subsequent shortening due to injury to the muscle. 6,64,65 Our results are in agreement with those reported previously. 4,25,[35][36][37][38] For recurrence (re-ankylosis), the metaanalysis showed a statistically significant difference between GA and IPG (OR 3.15, P = 0.02).…”

“…This is consistent with the results of previous studies. 45,47,59,64 With recent improvements in technology, alloplastic TMJ reconstruction is gaining popularity, with potential advantages including mimicking the normal anatomy and restoring vertical dimension, avoidance of donor site morbidity, reduction in operating time, reduction in joint pain, a reduced risk of recurrent ankylosis, improved aesthetic results, and immediate physiotherapy can be given. 47,59,71 However, alloplastic TMJ reconstruction materials are typically not useful in growing patients and they are expensive.…”

Dental management of patients with microstomia. A review of the literature and update on the treatment.

“…With respect to the treatment of microstomia, surgical procedures that involve the surgical reconstruction of oral commissures and non-invasive procedures such as oral physiotherapy, together with the use of static and dynamic devices have been proposed. These devices provide resistance to the retraction of the scar promoting stretching and mobility 3,10 . However, to date, most surgical techniques to treat microstomia are complex and have a high rate of recurrence, affecting aesthetics and functionality.…”

“…Non-surgical procedures for treating microstomia are based on oral physiotherapy and the use of both static and dynamic devices to provide resistance to scar contraction or for promoting stretching and mobility respectively 3,10 . These devices are designed to reduce scarring and keep normal functions 10 .…”

Management of subarachnoid haemorrhage in a non‐neurosurgical centre

“…Both conventional general and regional anaesthesia are acceptable and perioperative blood pressure management should follow normal practice. However, it should be remembered that after temporal craniotomy, the patient can have decreased mouth opening that may contribute to difficulty with laryngoscopy [104]. This is a common and underrecognised complication.…”