A 30-year old Nigerian male approached for correction of his locked jaw. At age of 12 years he had a fall and subsequently had a progressive reduction of mouth opening. For the past 18 years he had very much reduced mouth opening. One can appreciate the thick callus- causing fusion of the skull and the mandible – a local dentist removed two front teeth to facilitate feeding. The surgical plan is to access the TMJ correct the fused bone, ensure that there would be no further fusion. He cannot be anaesthetized via conventional methods – Hence a blind, awake intubation was performed. After achieving desired anesthesia, a pre-auricular approach was used. Alkayat and Bramley preauricular incision was used to reach the TMJ. Care was exercised to carefully handle temporalis fascia and muscle. The periosteum was left intact. Facial nerve was also carefully handled. Coronoidotomy was performed. Callus completely removed. Temporalis muscle was fit in to the cranium and head of the mandibular condlyle so that it does not fuse again. Mouth opening was checked before closure. A drain was placed to avoid hematoma. He was able to open his mouth comfortably and is on physiotherapy.
Posted on: Sun, 07 Dec 2014 17:08:48 +0000
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