RESUMO
INTRODUCTION: Among the skeletal causes of limited mouth opening, uni- or bilateral coronoid process hypertrophy, or Langenbeck disease, is the most frequent. It can be associated with an osteochondroma or a coronoid-malar bone conflict and is then called Jacob disease, an unilateral pathology. Treatment rests on coronoidectomy in both cases. This technique is illustrated via two cases, one Langenbeck and one Jacob disease. TECHNICAL NOTE: A transoral approach was performed. After subperiosteal dissection, the coronoid process was cleared. The process was than severed at its base by means of a burr, freed from its temporal muscular fibers and removed. Mouth opening improved peroperatively. The surgical procedure was completed by active long-term physiotherapy beginning immediately after surgery. DISCUSSION: Transoral coronoidectomy is a simple, quick and safe procedure. Extra-oral approaches present a high risk of facial nerve injury. In our first case, mouth opening improved from 24 to 36 mm after bilateral coronoidectomy and to 40 mm after physiotherapy. In our second case, mouth opening improved from 22 to 38 mm after unilateral coronoidectomy and to 43 mm after one year physiotherapy. Long-term post-operative physiotherapy is mandatory to get and maintain good results.
Assuntos
Anquilose/cirurgia , Mandíbula/cirurgia , Doenças da Boca/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Articulação Temporomandibular/cirurgia , Zigoma/cirurgia , Anquilose/etiologia , Anquilose/patologia , Anquilose/reabilitação , Humanos , Mandíbula/fisiologia , Neoplasias Mandibulares/complicações , Neoplasias Mandibulares/patologia , Neoplasias Mandibulares/reabilitação , Neoplasias Mandibulares/cirurgia , Doenças da Boca/patologia , Doenças da Boca/fisiopatologia , Doenças da Boca/reabilitação , Procedimentos Cirúrgicos Bucais/reabilitação , Osteocondroma/complicações , Osteocondroma/patologia , Osteocondroma/reabilitação , Osteocondroma/cirurgia , Amplitude de Movimento Articular/fisiologia , Articulação Temporomandibular/patologia , Articulação Temporomandibular/fisiologia , Zigoma/patologiaAssuntos
Neoplasias Femorais/etiologia , Neoplasias Femorais/reabilitação , Luxação do Quadril/complicações , Luxação do Quadril/reabilitação , Lesões do Quadril/complicações , Lesões do Quadril/diagnóstico , Osteocondroma/etiologia , Osteocondroma/reabilitação , Acidentes de Trânsito , Criança , Feminino , Neoplasias Femorais/diagnóstico , Luxação do Quadril/diagnóstico , Lesões do Quadril/reabilitação , Humanos , Osteocondroma/diagnóstico , Resultado do TratamentoRESUMO
Our aim was to investigate the outcome of excision ofosteochondromas. Between 1994 and 1998, 92 symptomatic osteochondromas in 86 patients were excised. There were 40 women and 46 men with a mean age of 20 years (3 to 62). Of these, 56 had a solitary osteochondroma and 30 had multiple hereditary tumours. The presenting symptoms were pain (79.1%), swelling (23.3%), reduced range of movement (19.8%), cosmetic abnormalities (17.4%), and bursitis (12.8%). The most common site (37.6%) was around the knee. Four patients had major complications (4.7%) including one intra-operative fracture of the femoral neck and three nerve palsies which resolved after decompression. Six patients had minor complications. Overall, 93.4% of the preoperative symptoms resolved after excision of the tumours. Excision is a successful form of treatment for symptomatic osteochondromas with a low morbidity.
