Coronoid Process Of The Mandible Research Articles

Direct anterior bone block grafting for treatment of bone defects and dysplasia of the coronoid process

The aim of the surgery was to treat an elbow instability caused by critical coronoid bone loss (CCBL), lateral ulnar collateral ligament (LUCL) insufficiency,and general hyperlaxity by performing adirect anterior coronoid bone graft (CBG) and LUCL reconstruction in the same setting. In cases with CCBL isolated ligament reconstruction harbors ahigh failure rate, necessitating supplementary bony procedures. The diagnosis of CCBL is confirmed through lateral radiographs and further quantified through computed tomography (CT) imaging. Objective assessment of instability is conducted with standardized arthroscopic tests. Performing an anterior approach for CBG offers distinct advantages, notably in terms of achieving precise positioning of plates and screws and providing access to the proximal radioulnar joint. Usual contraindications to surgery, coronoid bone loss less than 40%. The surgical procedure is thoroughly illustrated with avideo of the operation that can be accessed online: reconstruction of the LUCL with asemitendinosus allograft, harvesting of the graft from the iliac crest, exposure of the coronoid process with adirect anterior approach, freshening up of the graft bed. Temporary fixation of the graft with aKirschner wire. Assessment of joint congruency, stability and range of motion (ROM) prior to definitive fixation with a2.4 mm buttress plate and screws. Nonsteroidal anti-inflammatory drugs (NSAID) to prevent heterotopic ossification. Elbow mobilization in pronation from day1 with an overhead motion protocol. Removable splint for 4weeks, free mobilization at 6weeks, return to sport at 3months. Durable elbow stability was achieved along with free ROM and high patient satisfaction.

Clinical presentation and management of osteochondroma of the coronoid process (Jacob’s disease)

ABSTRACT Jacob’s disease is characterized by osteochondroma arising from the coronoid process of the mandible. Patients usually present with limitations of mouth opening and cheek prominence. Computed tomography of facial bones with three-dimensional reconstruction was considered the gold standard for diagnosis. Management was principally surgical which involved the removal of the coronoid process either by intraoral or extraoral approach. Postsurgical mouth-opening exercises are considered important for maintaining the obtained results.

Direct Anterior Bone Block Grafting for Coronoid Bone Loss and Dysplasia

Background: Critical coronoid bone loss (CCBL) can be the key factor of elbow instability, making bony reconstruction essential. Coronoid bone grafting (CBG) is challenging, with a paucity of descriptions in the literature. We present direct anterior CBG in a patient with instability, CCBL (>40%), lateral ulnar collateral ligament (LUCL) insufficiency, and ligamentous laxity who underwent LUCL reconstruction in the same setting. Indications: Isolated ligament reconstruction has a high failure rate in cases with CCBL and therefore requires additional bone grafting. The diagnosis of CCBL is made with lateral radiographs and further quantified by computed tomography imaging. Instability can be best assessed objectively during arthroscopy with a switching stick. CBG performed with an anterior approach facilitates direct access with advantages for plate and screw positioning and access to the proximal radio-ulnar joint. Technique Description: First, LUCL reconstruction was performed. After harvesting of the graft from the iliac crest, the coronoid was exposed with a direct anterior approach. The incision starts centrally medial to the biceps tendon (BT) in the flexion crease extending distally (9 cm). Ligation of multiple vessels (leash of Henry) is required. The deep dissection is continued between the bicipital aponeurosis and BT. Blunt and flat Langenbeck-type retractors are used with care, laterally (BT/radial nerve) and medially (aponeurosis/median nerve). The brachialis muscle is exposed and longitudinally split in line with its fibers, gaining access to the capsule. Harmful retraction on either side of the split has to be avoided. The capsule is incised as a Z-plasty, the coronoid exposed from the joint in the distal direction prior to freshening up the graft bed. The graft is held in place with a wire joystick, sculpted, and temporarily fixed. Joint congruency, stability, and a range of motion (ROM) are checked prior to definitive fixation with a 2.4-mm buttress plate and screws. Results: The coronoid process height was successfully reconstructed from <60% to 100% with durable elbow stability (>1 year), free ROM, and high patient satisfaction. Conclusion: CBG can be standardized and facilitated with a direct anterior approach as a key element for successful elbow stabilization in the setting of CCBL. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

The coronoid opening angle: a novel radiographic technique to assess bone loss in coronoid trauma.

Elbow fracture dislocations are complex injuries that often require surgical treatment in order to obtain a stable and congruent elbow joint. The coronoid plays a key role in the stability of this joint. Accurately identifying the degree of coronoid bone loss in the setting of traumatic elbow injuries is challenging. The purpose of this study is to describe a newradiographic measure, the coronoid opening angle (COA), to assist in estimating bone loss in these challenging fractures. Radiographs were drawn from a regional database in a consecutive fashion. Candidate radiographs were excluded on the basis of radiographic evidence of degenerative changes, previous surgery or injury, bony deformity, and inadequate lateral view of the elbow. Normal COA, coronoid height, and calculated COA at varying amounts of bone loss were determined by 3 reviewers. A total of 120 subjects were included. The normal coronoid opening angle was 34° (95% CI 32.9°-34.0°) and the coronoid height, 18.8 mm (18.1-19.6). Ninety-five percent of the population had an opening angle greater than 29° (95% CI 27.2°-29°). The COA limit was calculated at 20%, 33%, and 50% of baseline coronoid height corresponding to degree of bone loss. Coronoid opening angles of 24°, 20°, and 16°, respectively, indicate the minimum bone loss of interest in 95% of the population. The intraclass correlation coefficient was found to be 0.89 or higher. In the setting of elbow trauma, it is often challenging to predict the amount of coronoid bone loss. The coronoid opening angle is a newtechnique and an adjunct for lateral elbow radiographs to predict the minimum coronoid bone loss. This can be used to guide clinical decision making, aid in predicting instability, and guide treatment. Future research will aim to validate this tool in the clinical trauma setting.

Orthopantomography and use of Mandibular Indices for the Evaluation of Gender Distribution in Navi Mumbai Population - A Retrospective, Single Blind Study

Introduction: The study of forensic sciences often leaves the forensic expert to draw conclusions from any and every material available in determining the identity of the deceased. The initial step in identifying a person is to determine their gender based on their adult skeleton. The human skeleton displays sexual dimorphism, of which the skull is most dimorphic providing an accurateness of 92%. However, in certain situations where the skull may not be found intact, the mandible plays a vital role. The mandible's thick covering of compact bone helps keep it from exploding during a mass tragedy. Dimorphism in the mandible is gender specific and is mainly reflected in its shape and size. The mandible is also easily radiographed and specific linear measurements of the mandibular rami as seen on an OPG are useful indices for gender determination. 
 Aims: To examine the efficacy of mandibular rami measures such as maximum ramus breadth, maximum ramus height, minimum ramus breadth, condylar height, coronoid height, mandibular body length and gonial angles on the right and left side of an OPG in determining gender.
 Materials and methods: 110 digital OPG’s (55 males, 55 females) of a Navi Mumbai population were obtained retrospectively from a reputed dental college and hospital. The OPG’s were taken using Xtropan 2000 OPG machine, 10x12 PSP plates, exposure parameters of 75 Kvp, 8 mas, 13 sec, and KODAK CR 7400 digitizer. Master View 3.0 software was used on the desktop computer to measure the mandibular ramus's width and thickness. Maximum ramus breadth, Maximum Ramus height and lowest ramus breadth of the mandibular rami, as well as the height of the condyle and the coronoid bone, and the length of the mandibular body and gonial angles on the right and left sides of the mouth, were all measured. Using a statistical formula, the measurements were substituted and gender was estimated.
 Result: We used the IBM SPSS v 21.0 statistical software for social sciences to do our statistical study. p0.05 was deemed statistically significant, with a 5% margin of error and a 20% margin of error, giving the study an 80 percent power. In the study group, 51 of the 55 men were expected to be males, while 49 of the 55 females were anticipated to be females, while 6 of the 55 females were predicted to be males.
 Conclusion: This research shows that the mandibular ramus is a useful tool for determining gender, and digital panoramic imaging yielded the best accurate linear measures. There was considerable sexual dimorphism in the mandibular ramus in the chosen Navi – Mumbai subpopulation, and the combination of 8 factors demonstrated an accuracy of 91.81 percent and was helpful for gender determination.

Jacob’s Disease: case report

ABSTRACT Jacob’s disease or osteochondroma is a rare disease that presents as a pseudo-joint between the coronoid process of the mandible and the posterior surface of the zygomatic bone. The present case report is of an 11-year-old female patient with a maximum mouth opening of 2mm. When evaluating computed tomography with three-dimensional reconstruction, a mushroom-shaped increase in the coronoid process of the mandible on the left side was observed, intimately connected to the zygomatic bone (inferoposterior region of the body of the zygoma), which suggests a pseudoarticulation. Surgical removal of the tumor mass was performed under general anesthesia via intraoral access and is called coronoidectomy. Histopathological, the presence of hyaline cartilage was observed, a condition that is pathognomonic for Jacob’s Disease. Jacob’s disease case reports are still rare in the literature, with mushroom shape and histopathological confirmation due to the presence of hyaline cartilage.

The Effects of Relationship Between the Mixed Typed of Lingula and Coronoid Process of the Mandible

The Effects of Relationship Between the Mixed Typed of Lingula and Coronoid Process of the Mandible

Coronoid Foramina in a Pediatric Mandible: An Incidental Finding of a Morphologic and Developmental Anatomic Variant as a Distinctive Documented Feature

The new advancing technologies have created a storm in the long-existing canons of anatomic sciences with the bandwagon of recent anatomical discoveries such as the existence and identification of a bilateral foramen in the coronoid process of the mandible. The coronoid process being a thin flat triangular process varies in shape and size and gives attachment to the main muscles of mastication the temporalis and the masseter. The excitement of exploratory anatomic victory on mysteries related to the anatomy of the head-and-neck region specific to the coronoid process was further documented and elaborated as an incidental finding. The following manuscript presents an intriguing case of a pediatric patient aged 7 years with a morphologic variation of coronoid process with presence of foramina bilaterally along with few other variants, further attempting to emphasize its occurrence in the developmental years as a possibility of developmental variant trait.

Treatment of hyperplasia of the coronoid process of the mandible in adults: analysis of 42 literature reports and illustrative case

ABSTRACT Objective: The objective of this research was to review the literature, compare different methods of surgical treatment for coronoid hyperplasia and report a clinical case of unilateral coronoid hyperplasia treated by coronoidectomy with intraoral access. Methods: A critical review of the literature was performed by selection of papers published in the last 20 years on the treatment of coronoid in adults in the PubMed, Medline, Scielo and Lilacs databases, with the terms coronoid hyperplasia OR coronoid elongation AND treatment OR management. The data was extracted for analysis. Results: twenty-four articles were selected. It included 42 patients, among them 69% were male patients and 81% were bilaterally affected. The age group with the highest prevalence was the people in the 20's and 30's. Sixty-nine percent of the patients were treated with coronoidectomy and 26.2% with coronoidotomy. The majority (83.3%) with intraoral access. No cases had surgical complications reported, and 71.4% underwent physiotherapy after surgery. Regarding the results, 83.3% were considered satisfactory, 11.9% were unsatisfactory. Conclusion: The great majority of the cases that brought significant results in the improvement of the pre and postoperative mouth opening were treated by coronoidectomy, proving to be an efficient and safe surgical treatment for the coronoid hyperplasia.

Lower jaw morphology of Adalatherium hui (Mammalia, Gondwanatheria) from the Late Cretaceous of Madagascar

ABSTRACT The lower jaw of the holotype of Adalatherium hui, from the Late Cretaceous of Madagascar, is the most complete yet known for a gondwanatherian mammal. It reveals for the first time the morphology of the character-rich ascending ramus of the dentary in a gondwanatherian. Each half of the lower jaw is composed of only one bone, the dentary, which is short and deep and houses only five teeth: an enlarged, procumbent incisor and four postcanine teeth. In comparable parts of its anatomy, the dentary of Adalatherium is strikingly similar to that of Sudamerica but differs slightly from that of Galulatherium (conformation anterior to first postcanine, mental foramen position), the only two other gondwanatherians represented by complete horizontal rami. Among other Mesozoic mammaliaform taxa, the dentary of Adalatherium is most similar to those of the largely Laurasian group Multituberculata, most notably in absence of postdentary trough and Meckelian sulcus; presence of short, deep dentary with sizable diastema and articulating with squamosal via mediolaterally narrow condyle that continues onto posterior surface (i.e., no distinct peduncle); possession of much reduced dentition; absence of angular process; possession of large pterygoid fossa and pterygoid shelf, ventral surface of which is flat; absence of coronoid bone; and possession of unfused mandibular symphysis. Most of these features are clearly derived and stand in stark contrast to the much more plesiomorphic morphology exhibited by the lower jaw of the haramiyaviid Haramiyavia. The lower jaws of euharamiyidans, although derived in their own right, are also relatively plesiomorphic.

Morphology of Coronoid Process of the Mandible

Morphology of Coronoid Process of the Mandible

Suprazygomatic maxillary nerve block: an ultrasound and cadaveric study to identify correct sonoanatomical landmarks.

Following an ultrasound-guided SMB with dye injection on 2 embalmed cadavers, pre-tragal face-lift style incision with a full thickness flap dissection was performed allowing accurate visualization of the bony landmarks being used for sonography and identification of the location of the injected dye. This study identifies the correct sonoanatomic landmarks as the maxilla and the coronoid process of the mandible which suggests that the block needle tip and local anesthetic injection are within the infratemporal fossa as opposed to the previously reported pterygopalatine fossa. An improved understanding of the sonoanatomy will aid clinicians who are learning, performing and teaching the ultrasound-guided suprazygomatic approach to the maxillary nerve block.

Mandibular nerve block in juvenile Nile crocodile: a cadaveric study

ObjectiveTo develop a technique for performing the mandibular nerve block in Nile crocodiles. Study designExperimental cadaveric study. AnimalsA total of 16 juvenile Nile crocodile heads. MethodsTo study the course of the mandibular nerve, one head was dissected. Computed tomography (CT) examination was performed in two heads to identify useful landmarks. Thereafter, a hypodermic needle was inserted through the external mandibular fenestra of 17 hemimandibles (13 heads), and a mixture of methylene blue and iohexol was injected. Injection volumes were 0.5 (n = 7) and 1.0 mL (n = 10) for hemimandibles < 15 and ≥ 15 cm long, respectively. Iohexol spread and nerve staining with methylene blue were assessed with CT and anatomical dissection, respectively. Data were analysed with one-sample t test or Mann–Whitney U test. Significance was set at p < 0.05. ResultsBoth anatomical dissection and imaging confirmed the external mandibular fenestra as a useful anatomical landmark for needle insertion. The CT images acquired after needle positioning confirmed that its tip was located on the medial bony mandibular surface formed by the fusion of the angular and coronoid bones in 100% cases. In all the hemimandibles, the rostrocaudal spread of contrast was > 23 mm. The length of the stained mandibular nerve in the temporal region and of the stained medial branch of the mandibular nerve, as well as the dorsoventral and mediolateral spread of iohexol, was greater in group 1.0 than in group 0.5 (p < 0.001). The caudal spread of iohexol was greater in group 1.0 than in group 0.5 (p = 0.01). Conclusions and clinical relevanceThe technique developed in this study is feasible. Both injection volumes resulted in staining of the mandibular nerve. The spread of contrast in the anatomical region of interest may result in successful sensory block.

Is there an asymmetry of the condylar and coronoid processes of the mandible in individuals with unilateral crossbite?

To evaluate if there is a true skeletal asymmetry of the condylar and coronoid processes of the mandible in growing individuals with unilateral posterior crossbite (UPC) either functional or not. This cross-sectional study screened a total of 1120 cone beam computed tomography (CBCT) scans based on inclusion and exclusion criteria. The final sample comprised 20 CBCT images of individuals with UPC and 19 CBCT images of individuals without transverse malocclusion. The lengths of the condylar and coronoid processes were measured to evaluate asymmetry, as well as the magnitude of the mandibular lateral deviation in the UPC group. There was a significant difference between the lengths of the affected and nonaffected sides of the coronoid processes in the UPC group (P < .01). The same was not observed in the condyle in the UPC group (P > .05). There were no significant differences between the groups (P > .05). Although no differences in the condyle were observed, the coronoid process was asymmetric in individuals with UPC. However, this asymmetry was not considered to be clinically significant.

The influence of bilateral hyperplasia of the coronoid process of the mandible for difficult tracheal intubation

Bilateral hyperplasia of the coronoid process of the mandible is rare condition. Commonly there is only one mechanical symptom, limiting mouth opening. The aim of this article is to introduct medical history of a 38 year-old female with bilateral hyperplasia of the coronoid process of the mandible confirmed by examination and RTG diagnostic. There is also the question of difficulties during intubation due to bilateral hyperplasia in this case.

Feline (Felis catus) Skull and Pelvic Morphology and Morphometry: Gender-Related Difference?

This study demonstrates sexual dimorphism of feline bones, based on a morphometric analysis of 38 dried feline skulls and pelvic bones (20 males, 18 females). A total of 44 parameters (skull=12, mandible=10, pelvis=22) were measured using a digital vernier calliper. In morphological observation of these bones, there were three hallmarks indicating a remarkable difference between sexes: the coronoid process of the mandible (accuracy rate=88.2%); and the os coxae - caudal ventral iliac spine (accuracy rate=94.4%), and the angle of the ischiatic arch (accuracy rate=74.3%). In addition, based on morphometric characteristics, six parameters were found to be significantly different (P<0.05) between males and females, consisting of one in the mandible and five in the pelvis, but no parameters in the skull. Effective equations to discriminate gender were generated through a stepwise discriminant analysis from feline mandible and pelvic bones. Our findings showed that an equationfrom the pelvic bones, Y=[-16.066*T/O]+[2.559*IC/PS]+[13.357*TTL/ISA]-[4.478], appeared to be more applicable with a 97.3% accuracy rate, while a function from the mandible gave a 64.9% accuracy rate. In conclusion, we suggest that an equationfrom feline pelvic measurements and three hallmarks, one on the mandible and two on the os coxae, can be used for sex estimation.

Two new Actinopterygii (Vertebrata, Osteichthyes) with cosmine from the Bear Gulch Limestone (Heath Fm., Serpukhovian, Mississippian) of Montana USA

ABSTRACT. The osteology and histology of two new actinopterygians, Paphosiscus circulocaudus new genus and species, and P. scalmocristus new species, are described from the Upper Mississippian Serpukhovian Bear Gulch Member of the Heath Formation of Montana (USA). These small fish (ca 50–58mm standard length) exhibit head bones and scales with cosmine, the first report of this in any actinopterygian. Other features of Paphosiscus are dorsal, anal and caudal fin margins round posteriorly, dorsal fin long with horizontal dorsal margin and achieving its greatest height immediately before its rounded posterior margin, tall unpaired predorsal ridge scales/fulcra, premaxillae not sutured to other bones, single postrostral bone, one otic canal bone (dermopterotic), dermosphenotic absent as distinct bone, mandibular articulation level with mandibular tooth row, a coronoid process, marginal teeth pleurodont, coronoid teeth with blunt crowns on a single coronoid bone. Species differ in size and features of cranial ...

A Study of Various Forms of Mandibular Coronoid Process in Determination of Sex

The coronoid process of the mandible is gaining vital importance as a graft material in reconstructive craniomaxillofacial surgeries and as a non metric skull variant in assessment of age, sex, race and species. Hence the present study was taken to assess the different forms of the coronoid process existing in Indian adult population on both sides and to assess the feasibility of using this knowledge in identification of sex. The study includes 50 male and 50 female mandibles which were collected from various medical colleges. The various presentations of coronoid process were observed and broadly classified, on both the sides. Statistical analysis was calculated using Chi-square test. Hook shaped coronoid process was the most predominant type (61.5%) followed by triangular (14%) and rounded (12.5%) types. About 12% belonged to the miscellaneous type. Hook shape coronoid process was significantly higher in the females. The other shapes did not show any significant gender variation. From the present study it was inferred that the structural changes at the coronoid process of mandible help oneself to distinguish the gender of the individual.

Facial reanimation utilizing combined orthodromic temporalis muscle flap and end-to-side cross-face nerve grafts.

Individuals with facial paralysis of 6 months or more without evidence of clinical or electromyographic improvement have been successfully reanimated utilizing an orthodromic temporalis transfer in conjunction with end-to-side cross-face nerve grafts. The temporalis muscle insertion is released from the coronoid process of the mandible and sutured to a fascia lata graft that is secured distally to the commissure and paralyzed hemilip. The orthodromic transfer of the temporalis muscle overcomes the concave temporal deformity and zygomatic fullness produced by the turning down of the central third of the muscle (Gillies procedure) while yielding stronger muscle contraction and a more symmetric smile. The muscle flap is combined with cross-face sural nerve grafts utilizing end-to-side neurorrhaphies to import myelinated motor fibers to the paralyzed muscles of facial expression in the midface and perioral region. Cross-face nerve grafting provides the potential for true spontaneous facial motion. We feel that the synergy created by the combination of techniques can perhaps produce a more symmetrical and synchronized smile than either procedure in isolation. Nineteen patients underwent an orthodromic temporalis muscle flap in conjunction with cross-face (buccal-buccal with end-to-side neurorrhaphy) nerve grafts. To evaluate the symmetry of the smile, we measured the length of the two hemilips (normal and affected) using the CorelDRAW X3 software. Measurements were obtained in the pre- and postoperative period and compared for symmetry. There was significant improvement in smile symmetry in 89.5 % of patients. Orthodromic temporalis muscle transfer in conjunction with cross face nerve grafts creates a synergistic effect frequently producing an aesthetic, symmetric smile. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .

Simultaneous Chin Onlay Bone Graft Using Elongated Coronoid in the Treatment of Temporomandibular Joint Ankylosis

Temporomandibular joint (TMJ) ankylosis is a disabling condition that causes problems in mastication, digestion, speech, appearance, and hygiene. Treatment goals are to restore the joint function, to improve facial appearance, and to reestablish harmony among them. To achieve these goals, various strategies have been reported as 1-stage or multistage protocols. We describe a novel method to augment the chin structure with elongated coronoid process of the mandible, which is a sequence of TMJ ankylosis. By this 1-stage treatment that includes gap arthroplasty with interpositional temporalis fascia graft and chin augmentation with autogenous bone graft (elongated coronoid), functional disability and facial deformity of the patient with TMJ ankylosis were improved simultaneously.