J Korean Assoc Oral Maxillofac Surg.  2024 Apr;50(2):110-115. 10.5125/jkaoms.2024.50.2.110.

Anatomical study to determine a new approach to treat benign masses located in the anterior condyle region: a case report

• Kim SG
• Bok SC
• Choi SI
• Park JW
• Choi DJ

• KMID: 2555741
• DOI: http://doi.org/10.5125/jkaoms.2024.50.2.110

Abstract

A 22-year-old male patient presented to the clinic with severe pain in the preauricular area with an inability to completely occlude the jaw. Facial computed tomography and magnetic resonance imaging revealed a well-defined lesion that was tentatively diagnosed as a benign tumor or cystic mass. Surgical approach of a lesion in the condyle is delicate and problematic as many vulnerable anatomical structures are present. There are several methods for surgery in this area. Typically, an extraoral approach is dangerous because of potential injuries to nerves and arteries. The intraoral approach also presents difficulties due to the lack of visibility and accessibility. On occasion, coronoidectomy may be performed. The goal here was to determine an easier and safer new surgical approach to the condyle. We reached the anterior part of the pterygoid plate in the same method as in Le Fort I surgery. From this point, through the external pterygoid muscle, approaching the anterior aspect of the condyle is relatively easy and safe, with minimal damage to the surrounding tissues. Pus was drained at the site, and the lesion was diagnosed as an abscess. Pain and inability to close the mouth resolved without recurrence.

Keyword

Intraoral approach; Letral pterygoid muscle; Safe

Figure

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  Fig. 1 Panoramic view. The patient was referred from a local clinic for extraction of #38. His chief complaint was severe pain around the left facial area with difficulty in mouth closing. He was diagnosed with referred pain from pericoronitis of #38. However, no lesion was observed in the #38 area and the patient had no previous history of pain.

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  Fig. 2 A computed tomography view showing the tumorous lesion, located from the anterior portion of the condyle to the posterior portion of the pterygoid plate and from the condylar head to the sigmoid notch.

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  Fig. 3 Coronal view of computed tomography showing a liquid-like mass in the upper and lower areas of the pterygoid muscle.

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  Fig. 4 Magnetic resonance imaging showing a liquified lesion indicating an abscess and ruling out a liquid-containing benign tumor.

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  Fig. 5 An incision line was created from the premolar region and extended through the anterior border of the mandible. The maxillary area was dissected fully to expose bone, while the mandibular portion was dissected with partial thickness.

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  Fig. 6 The incision was completed at the submucosal level. The fat pad was observed at the antero-superior aspect of the coronoid process and was moved laterally to not disturb the surgical field.

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  Fig. 7 Pus draining from the space of the external pterygoid muscle.

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  Fig. 8 Approach path to the external pterygoid muscle: From the maxillary tuberosity, Kelly forceps were used to penetrate the fascia of the external pterygoid muscle to reach the anterior part of the condyle.

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  Fig. 9 Sutured site from the surgical approach.

Reference

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