Subjective:
The patient was referred to our office by his general dentist with a chief complaint; "I can't open my mouth like I could before my accident."
Objective:
The patient is from an adjacent county, was involved in a four wheeler accident and was air evacuated to a university hospital for treatment of his facial injuries.
The patient is a 44 y.o. male allergic to Ativan. Medications included Prinivil 10 mg for hypertension. The patient had a tracheostomy and closed reduction of his bilateral mandibular fractures. In addition, the patient had a closed head injury, basilar skull fracture, and multiple facial lacerations. After 6 weeks of intermaxillary fixation (IMF) the patient was noted to have a malocclusion when the IMF was removed. The patient was retreated at the university with an open reduction, rigid internal fixation, and IMF for a left mandibular angle fracture nonunion. The patient was in IMF the months of October, November, and December.
The patient was 11 months post treatment at the university and had failed to respond to TMJ range of motion exercises.
Examination revealed an interincisal opening of 25 mm. Palpation of the TMJ region indicated no translation of the left mandibular condylar head upon opening the mouth. A pre-existing malocclusion with an anterior posterior discrepancy between the incisors was noted. A mild facial nerve palsy was noted of the left marginal mandibular branch of the facial nerve. Tomograms and C.A.T. scans of the facial skeleton revealed:
- Sclerosis and deformity of the left mandibular condyle.
- No translation of the left condyle from closed to open mouth position.
- Anterior displacement of the right mandibular condylar head from fracture.
- Comminuted fracture of the left glenoid fossa with the left condylar head displaced upward 4 mm into the middle cranial fossa.
Panoramic | 
Tomogram | 
C.A.T. Scan | 
Preoperative |
Assessment:
- Osseous Ankylosis of the Left Temporomandibular Joint (TMJ) (Mandibular Hypomobility)
Plan / Treatment:
- Left Mandibular Subcondylar Interpositional Gap Arthroplasty
- Left Mandibular Coronoidectomy
- Right Mandibular Coronoidectomy (Intraoral Approach)
- Removal of Mandibular Bone Plate and Screws
- Application of Maxillary and Mandibular Arch Bars
- Postoperative TMJ Range of Motion Exercises
Risdon Approach | 
Bone Plate | 
Subcondylar Gap
Arthroplasty | 
Interpositional .040
Silastic Sheeting |
Intraoperative | 
6 weeks postoperative | 
6 months postoperative |
Patient treated by:
- Dr. Steven R. Tucker Oral and Maxillofacial Surgery
- Dr. Allan L. Reid Assistant Oral and Maxillofacial Surgery
- Dr. Dwaine Blakeman General Dentistry
Steven R. Tucker DMD, PSC
Oral and Maxillofacial Surgery
909 Scherm Road
Owensboro, KY 42301
phone: 1-270-926-4107
fax: 1-270-926-4166
url: www.srt-psc.com
Last Modified :November 1, 2000
