J Korean Assoc Oral Maxillofac Surg.  2012 Aug;38(4):249-254. 10.5125/jkaoms.2012.38.4.249.

Severe trismus due to bilateral coronoid process hyperplasia in growth hormone therapy patient: a case report

• Lee ST
• Chung IK

• KMID: 2189633
• DOI: http://doi.org/10.5125/jkaoms.2012.38.4.249

Abstract

Bilateral coronoid process hyperplasia is a rare condition characterized by an enlarged mandibular coronoid process. The painless progressive reduction of a mouth opening is caused by coronoid process impingement on the posterior aspect of the zygomatic bone. Hyperplasia of the bilateral coronoid process leads to the restriction of a mandibular opening consequent to the impingement of the enlarged coronoid process on the temporal surface of the zygomatic bone or with the medial surface of the zygomatic arch. The process has been diagnosed as developmental hyperplasia. Otherwise, the development of the coronoid process may be associated with growth hormone. This paper describes a case of trismus caused by coronoid hyperplasia in an idiopathic short-stature patient who received growth hormone therapy by somatropin injections.

Keyword

Coronoid process hyperplasia; Trismus

MeSH Terms

Growth Hormone
Human Growth Hormone
Humans
Hyperplasia
Mouth
Trismus
Zygoma
Growth Hormone
Human Growth Hormone

Figure

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  Fig. 1 Preoperative clinical photograph. A. Lateral photo view. B. Frontal photoview. C. Preoperaive maximum mouth opening mesurement was 10 mm.

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  Fig. 2 Preoperative radiologic view show both hyperplasic coronoid preocess. A. Panoramic view. B. Dental conbeam computed tomography (CT) view (mandible right). C. Dental conbeam CT view (mandible left).

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  Fig. 3 Three dimensional simplant image. A. The image show morphological abnomality of left zygomatic bone. B. Left coronoid process extend above the zygomatic bone and impinge on the posterior surface of the zygomatic bone. C. Right coronoid process have just hyperplastic morphology.

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  Fig. 4 Serial panoramic view. A. April 2006. B. August 2007. C. August 2008 after growth hormone therapy (January 2008). D. July 2011.

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  Fig. 5 A. Perioperative mouth opening was 10 mm. B. Mouth opening after left coronoidectomy was 40 mm. C. Mouth opening after both coronoidectomy was 53 mm.

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  Fig. 6 A. Resected Lt. coronoid process. B. Lt. coronoid cartiladge from coronoid process tip. C. Comparison resected Lt. coronoid process with resected Rt. coronoid process. (Lt.: left, Rt.: right)

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  Fig. 7 A. One month mouth opening after surgery. B. Postoperative panoramic view.

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