The Role of Coronoidectomy in Complex Mandibular Reconstruction With Free Fibular Flap

Introduction: Complex mandibular reconstruction is at risk of postoperative restricted mouth opening. Temporomandibular joint pseudoankylosis can cause significant disability, leading to restricted mouth opening and an inability to create a proper seal with the mouth. Treating this condition often requires aggressive surgical intervention, primarily restoring the structure and functionality of the mandible. Coronoidectomy plays a vital role in improving mouth opening capacity. Case Presentation: Four patients with temporomandibular joint pseudoankylosis were included in this case series. The patients reported being unable to move their remaining lower jaw, having a perpetually open mouth, and constant drooling. All patients had a history of reconstructive surgery due to tumor or malignancy and could only open the mouth less than 10 mm. They underwent coronoidectomy followed by free fibular flap reconstruction. Postoperatively, all 4 patients exhibited a movable mandible and achieved proper occlusion. The maximum mouth opening increased by 25 to 45 mm; all flaps appeared vital, sutures remained intact, and no active bleeding. Discussion: Coronoidectomy is crucial for enhancing the ability to open the mouth. All of the patients underwent a coronoidectomy surgery followed by free fibular flap reconstruction. Immediately after the surgery, the mandibular projection appears nearly symmetrical, the patient opens their mouth, and occlusion is achieved subjectively. From our presented cases, after coronoidectomy, all patients had movable mandibula, and mouth opening was achieved. Coronoid process resection frees the mandible from the temporalis. Coronoidectomy and separation of the temporalis muscle from the mandible have excellent clinical efficacy for improving mouth opening and movement. Conclusion: Coronoidectomy followed by a free fibular flap should be considered the best surgical option for patients with restricted mouth opening after complex mandibular reconstruction.