Tratamento cirúrgico da limitação de abertura bucal causada por hiperplasia do processo coronoide: relato de caso / Surgical treatment for mouth opening limitation caused by coronoid process hyperplasia: case report

A hiperplasia do processo coronoide é uma condiçãoincomum de etiologia desconhecida que se apresentaclinicamente por meio da limitação de abertura bucal enão possui sintomatologia dolorosa durante a aberturae o fechamento bucal. Objetivo: relatar e discutir, pormeio de um caso cirúrgico, o tratamento da limitaçãode abertura bucal causada por hiperplasia bilateral doprocesso coronoide. Relato de caso: paciente do sexofeminino, com 11 anos de idade, foi encaminhada paraatendimento devido à dificuldade de mastigação emfunção da limitação de abertura bucal, sem históricode trauma em face ou na região articular. O exame tomográficoevidenciou o alongamento bilateral do processocoronoide, fazendo com que ele colidisse com oarco zigomático durante a abertura bucal e causasse otravamento. O tratamento proposto foi a coronoidectomiabilateral com acesso cirúrgico intraoral, obtendono pós-cirúrgico imediato um ganho na abertura bucal.Considerações finais: a coronoidectomia é uma abordagemcirúrgica de fácil acesso por via intraoral, poucotraumática e eficaz no tratamento de pacientes com hiperplasiado processo coronoide. (AU)

The coronoid process hyperplasia is an unusual condition of unknown etiology that is presented clinically through mouth opening limitation, without painful symptoms during mouth opening and closure. Objective: to report and discuss, through a surgical case, the treatment of mouth opening limitation caused by bilateral coronoid process hyperplasia. Case report: female patient, 11 years old, referred due to chewing difficulty by mouth opening limitation. No history of trauma in the face or joint area. The tomographic examination showed the bilateral elongation of the coronoid process, causing it to collide with the zygomatic arch during mouth opening, which caused locking. The treatment proposed was bilateral coronoidectomy with intraoral surgical access, which enhanced mouth opening at the immediate postoperative period. Final considerations: coronoidectomy is a surgical approach with easy intraoral access, non-traumatic, and effective in the treatment of patients with coronoid process hyperplasia. (AU)

Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation.

A Academia Americana de Dor Orofacial (AAOP) define anquilose da Articulação Temporomandibular (ATM) como restrição dos movimentos devido à adesão fibrosa intracapsular, alterações fibrosas nos ligamentos capsulares (fibroanquilose) e formação de massa óssea resultando na fusão dos componentes articulares (anquilose óssea). As características clínicas da Fibroanquilose são: capacidade severamente limitada de abertura bucal geralmente sem dor e sem ruídos articulares, com marcada deflexão para o lado afetado e marcada limitação de movimentos para o lado contralateral. Uma variedade de fatores pode causar anquilose da ATM, como trauma, condições inflamatórias locais e/ou sistêmicas, neoplasias e infecção na ATM. A artrite reumatóide (AR) é uma dessas condições sistêmicas inflamatórias que pode afetar a ATM e causar anquilose. O objetivo desse estudo é apresentar um caso de uma paciente, diagnosticada com Fibroanquilose da ATM bilateral e assintomática associada à AR. Esse caso ilustra a importância de um exame clínico bem realizado com exames complementares pode levar a um diagnóstico correto de Fibroanquilose da ATM e da importância do diagnóstico diferencial em casos de abertura bucal restrita.

Clinical Features of the Temporomandibular Disorder Patients with Occlusal Splint Therapy / 영남의대학술지

This study was performed to evaluate the clinical features and treatment results on 55 temporomandibular disorder patients who had treated by conservative treatment using occlusal splint. The results were as follows; 1. The ratio of men to women was about 1:2.2 and most of the patients were second and third decades. 2. Pain was the most frequent symptom, followed by clicking and mouth opening limitation. 3. The number of acute and chronic groups on the basis of 6 months duration of symptoms were similar. 4. Most of patients had Angle's Class 1 molar relationships(78.2%), followed by Class 3 and Class 2. 5. Centric Relation splints were used alone for treatment of 34 patients and 21 patients were treated with Centric Relation splints and Anterior Repositioning splints. The treatment duration of the patients who had complained pain was average 9.8 weeks and 6 patients of them had slight pain continuously during follow-up. 6. Eleven patient's maximum mouth opening who had mouth opening limitation was improved from 30.7mm to 43.0mm during procedures.