Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
권호 표지
DOI QR코드

DOI QR Code

Coronoid Process Hyperplasia: A Rare Case of Restricted Mouth Opening Masquerading as Temporomandibular Disorder

  • Juhyun Cha (Department of Oral Medicine, Seoul National University Dental Hospital) ;
  • Jin Woo Chung (Department of Oral Medicine, Seoul National University Dental Hospital)
  • Received : 2023.08.09
  • Accepted : 2023.08.28
  • Published : 2023.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Coronoid process hyperplasia (CPH) of the mandible is a rare condition in which abnormal elongation of the coronoid process leads to chronic mandibular hypomobility. CPH causes impingement or impedance of the coronoid process on the inner surface of the frontal part of the zygomatic bone during mouth opening. The lack of significant symptoms makes the diagnosis difficult. Its etiology remains inconclusive despite several theories being suggested. In this report, three reviewed cases are presented. All three patients visited our clinic with limited mouth opening as the chief complaint. Standard clinical and radiographic examinations were conducted under the initial impression of temporomandibular disorders (TMDs), and restricted jaw movements were confirmed in all cases. The absence of improved signs and symptoms following conservative treatment for TMDs or the indeterminate plain radiographs required the attending clinicians to consider three-dimensional imagery. Computed tomography revealed bilateral coronoid hyperplasia in all cases and impingement on the zygomatic bone in two of the three cases. After concluding that this condition caused the patients' limited mouth opening, the patients were referred to the Department of Oral and Maxillofacial Surgery for possible bilateral coronoidectomy or coronoidotomy. CPH usually presents no symptoms apart from a progressive reduction of mouth opening over time. Diagnosis is often delayed, and patients may undergo unnecessary treatment procedures. Clinicians should be aware of this condition and exercise caution in the differential diagnosis of patients with chronic mandibular hypomobility.

Keywords

References

  1. Okeson JP. Management of temporomandibular disorders and occlusion. 8th ed. Elsevier Health Sciences; 2020.
  2. Pregarz M, Fugazzola C, Consolo U, Andreis I, Beltramello A, Gotte P. Computed tomography and magnetic resonance imaging in the management of coronoid process hyperplasia: review of five cases. Dentomaxillofac Radiol 1998;27:215-220. https://doi.org/10.1038/sj.dmfr.4600353
  3. Gerbino G, Bianchi S, Bernardi M, Berrone S. Hyperplasia of the mandibular coronoid process: long-term follow-up after coronoidotomy. J Craniomaxillofac Surg 1997;25:169-173. https://doi.org/10.1016/S1010-5182(97)80010-8
  4. Yamaguchi T, Komatsu K, Yura S, Totsuka Y, Nagao Y, Inoue N. Electromyographic activity of the jaw-closing muscles before and after unilateral coronoidectomy performed on a patient with coronoid hyperplasia: a case study. Cranio 1998;16:275-282. https://doi.org/10.1080/08869634.1998.11746068
  5. Wenghoefer M, Martini M, Allam JP, Novak N, Reich R, Berge SJ. Hyperplasia of the coronoid process in patients with ankylosing spondylitis (Bechterew disease). J Craniofac Surg 2008;19:1114-1118. https://doi.org/10.1097/SCS.0b013e318176ac3b
  6. Bayar GR, Akcam T, Gulses A, Sencimen M, Gunhan O. An excessive coronoid hyperplasia with suspected traumatic etiology resulting in mandibular hypomobility. Cranio 2012;30:144-149. https://doi.org/10.1179/crn.2012.021
  7. Leonardi R, Caltabiano M, Lo Muzio L, et al. Bilateral hyperplasia of the mandibular coronoid processes in patients with nevoid basal cell carcinoma syndrome: an undescribed sign. Am J Med Genet 2002;110:400-403. https://doi.org/10.1002/ajmg.10432
  8. Goh YC, Tan CC, Lim D. Coronoid hyperplasia: a review. J Stomatol Oral Maxillofac Surg 2020;121:397-403. https://doi.org/10.1016/j.jormas.2019.12.019
  9. Holmlund AB, Gynther GW, Reinholt FP. Disk derangement and inflammatory changes in the posterior disk attachment of the temporomandibular joint: a histologic study. Oral Surg Oral Med Oral Pathol 1992;73:9-12. https://doi.org/10.1016/0030-4220(92)90145-G
  10. Ferretti C, Bryant R, Becker P, Lawrence C. Temporomandibular joint morphology following post-traumatic ankylosis in 26 patients. Int J Oral Maxillofac Surg 2005;34:376-381. https://doi.org/10.1016/j.ijom.2004.09.003
  11. Bell WE. Temporomandibular disorders: classification, diagnosis, management. 3rd ed. Year Book Medical Publishers; 1990. pp. 77.
  12. Capote A, Rodriguez FJ, Blasco A, Munoz MF. Jacob's disease associated with temporomandibular joint dysfunction: a case report. Med Oral Patol Oral Cir Bucal 2005;10:210-214.
  13. Loh HS, Ling SY, Lian CB, Shanmuhasuntharam P. Bilateral coronoid hyperplasia-a report with a view on its management. J Oral Rehabil 1997;24:782-787.
  14. Mulder CH, Kalaykova SI, Gortzak RAT. Coronoid process hyperplasia: a systematic review of the literature from 1995. Int J Oral Maxillofac Surg 2012;41:1483-1489. https://doi.org/10.1016/j.ijom.2012.03.029
  15. Yura S, Ohga N, Ooi K, Izumiyama Y. Mandibular coronoid hyperplasia: a case report. Cranio 2009;27:275-279. https://doi.org/10.1179/crn.2009.039
  16. Chen CM, Chen CM, Ho CM, Huang IY. Gap coronoidotomy for management of coronoid process hyperplasia of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:e1-e4. https://doi.org/10.1016/j.tripleo.2011.03.040
  17. Gibbons AJ, Abulhoul S. Use of a Therabite appliance in the management of bilateral mandibular coronoid hyperplasia. Br J Oral Maxillofac Surg 2007;45:505-506. https://doi.org/10.1016/j.bjoms.2006.05.005