Limited mouth opening of unknown cause cured by diagnostic coronoidectomy: a new clinical entity?
Limited mouth opening of unknown cause cured by diagnostic coronoidectomy: a new clinical entity?
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DOI：
10.1016/j.bjoms.2014.11.016
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发表时间：
2015-03-01
影响因子：
1.8
通讯作者：
Nitzan, D. W.
中科院分区：
文献类型：
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作者：
Lehman, H.;Fleissig, Y.;Nitzan, D. W.
开口受限是一个持续的烦恼，如果需要插管，可能会危及生命。原因很多，分为关节内或关节外，通常难以区分。我们提出了我们认为是一个新的临床实体长期有限的开口原因不明，并描述了我们的治疗。4例女性患者表现为张口受限、正常范围内的侧向和伸展运动，这是典型的关节外起源的限制。然而，放射学检查结果在正常范围内，没有明显的限制原因。所有四个人都接受了双侧冠状突切除术，导致口腔开口立即恢复到正常范围内，并在随后的几年中保持正常。组织学检查显示附着于冠状突的颞肌带萎缩和退行性变化，这可以解释颞肌僵硬，但不能解释发病机制。鉴于这种“诊断性冠状突切除术”，需要进一步的研究，以记录潜在的病理变化，并开发更准确的成像，使正确的诊断在未来。(C)2015年由Elsevier Ltd.代表英国口腔颌面外科医生协会发布。
Limited mouth opening is a constant annoyance and can be life-threatening should intubation be needed. The causes are numerous and are categorised as intra-articular or extra-articular, which are often difficult to distinguish. We present what we regard as a new clinical entity long-standing limited mouth opening of unknown cause and describe our treatment. Four female patients presented with limited mouth opening and lateral and protrusive movements within normal limits, which were typical of restriction of extra-articular origin. However, the radiological findings were within normal limits, with no visible cause of the restriction. All four were treated by bilateral coronoidectomy that resulted in the immediate return of mouth opening to within normal limits that was preserved over subsequent years. Histopathological examination showed atrophy and degenerative changes in the temporalis band that had been attached to the coronoid, which accounts for the stiffness of the temporalis muscle but does not explain the pathogenesis. In the light of this "diagnostic coronoidectomy" further studies are required to document the underlying pathological changes and to develop more accurate imaging that will enable correct diagnosis in future. (C) 2015 Published by Elsevier Ltd. on behalf of The British Association of Oral and Maxillofacial Surgeons.