JAPANESE JOURNAL OF ORAL & MAXILLOFACIAL SURGERY

Vol. 54 No. 3       2008

ISSN: 0021-5163      UBIC: 151-J

ABSTRACT

A case of severely limited mouth opening after craniotomy is reported. A 48-year-old woman was referred to our department for treatment of limited mouth opening. She had a medical history of a subtemporal and a lateral suboccipital craniotomy, with decreased mouth opening developing a month after the cranial surgery. The maximum inter-incisal distance was 7 mm, and no movement of the left temporomandibular joint was detected. Radiographic images revealed hyperplasia of the left mandibular head and lack of interarticular space. We planned treatment in 3 stages: initial operation (gap arthroplasty and insertion of an artificial membrane), physiotherapy after the operation, and secondary surgery (elimination of the membrane). During the initial surgery. maximum opening of the mouth increased from 7 mm to 21 mm. but muscle contracture was suspected to prevent further improvement. Therefore, coronoidectomy and removal of the masseter muscle were performed additionally. These procedures increased maximum opening to 47 mm. She started mouth-opening exercises with a gag OH the next day. The range of active motion increased from 22 mm to 35 mm. After discharge from our hospital, she continued home rehabilitation. Secondary surgery was performed 3 months after the initial surgery. She continued the same exercises, with less pain. Maximum opening of 41 mm has been maintained for 7 months after the initial surgery. Key words: mouth-opening limitation, gap arthroplasty, coronoidectomy, removal of masseter muscle, craniotomy.

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