📝 “What is the Coronoidectomy via Intraoral Approach?”

Quick Review #268 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #coronoidectomy2.26.25Indications:• Coronoid process hyperplasia• Trismus secondary to coronoid impingement (e.g., post-traumatic ankylosis, temporalis muscle hyperactivity)• Access to zygomatic arch fracturesSurgical Steps1. Preoperative Considerations• Assess mouth opening and obtain preoperative imaging (CT scan preferred).• Consider IV steroids to reduce postoperative edema.2. Anesthesia and Patient Positioning• General anesthesia with nasal intubation to maximize intraoral access.• Head tilted slightly toward the contralateral side.3. Intraoral Incision and Exposure• Use a mouth prop to maintain jaw opening.• A mucosal incision is made over the anterior border of the ramus, extending superiorly into the maxillary vestibule.• Subperiosteal dissection exposes the coronoid process, preserving the buccal fat pad to minimize fibrosis.• Retract the temporalis muscle superiorly to visualize the coronoid.4. Osteotomy and Removal of the Coronoid Process• Identify the coronoid process and ensure adequate exposure.• Use a reciprocating saw or osteotome to perform an osteotomy at the coronoid base, just superior to the sigmoid notch.• Remove the coronoid segment with forceps, taking care to avoid excessive traction on the temporalis.• If necessary, additional bone resection may be performed to improve range of motion.5. Hemostasis and Closure• Irrigate the site thoroughly to remove bone debris.• Achieve hemostasis with electrocautery or hemostatic agents.• Close the mucosal incision with absorbable sutures.Pearls* Adequate exposure – Proper subperiosteal dissection minimizes bleeding and facilitates visualization.* Preserve mucosal integrity – Avoid excessive stripping of periosteum to reduce fibrosis risk.* Controlled osteotomy – Use a reciprocating saw for a precise cut to avoid unnecessary trauma.* Immediate mobilization – Early physiotherapy prevents postoperative fibrosis and ankylosis.* Hemostasis – Cauterization of the pterygoid venous plexus minimizes bleeding.Pitfalls* Inadequate exposure – Poor visualization increases risk of damaging the temporalis muscle.* Excessive traction on the temporalis – May lead to postoperative pain and muscle dysfunction.* Injury to maxillary artery branches – Risk of excessive bleeding if deep dissection is not controlled.* Failure to initiate early physiotherapy – Can result in trismus and scar formation.* Over-resection – Removing excessive bone can weaken the mandible structurally.References:1. Ellis, E. III, & Schubert, W. (n.d.). Coronoid process fractures. AO Surgery Reference.2. Roy, T., & Reid, R. (2021). A novel approach to coronoidectomy: The modified Keen technique. Journal of Craniofacial Surgery, 32(3), 1150-1151.3. ChatGPT. 2025#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher