Isolated fracture of the coronoid process following a molar extraction: A rare case report

Abstract

Isolated coronoid process fractures are uncommon, and iatrogenic isolated fractures are extremely rare. This case describes a displaced fracture of an isolated coronoid process thought to be due to excessive force applied by a dentist that had been overlooked and left untreated for about a month. The patient was a woman in her late 50's and she had undergone a molar extraction. Her dentist had confused her symptoms of trismus, pain, and facial oedema with the complex tooth extraction procedure. Following a cone-beam computed tomography (CBCT) scan we showed that the mandibular coronoid process on her right side had suffered a longitudinal fracture, and the fractured fragment had rotated upwards and inwards. Following successful surgical elimination of the fragmented coronoid process, the patient received targeted physiotherapy sessions that yielded excellent results. At the five-month follow-up, the ability of the patient to open her mouth had improved enormously, and her facial appearance almost recovered to its original state.

Keywords: Dental extraction; coronoid process; mandibular fracture; oral surgery.

Figure 1.

(a & c) Cone-beam computed tomography (CT) images showing the fractured fragment of the coronoid process had rotated upwards and inwards. (b) A panoramic radiographic image shows the coronoid process on the right side had suffered a longitudinal fracture and (d) photograph of the patient’s mouth showing the opening was limited to approximately 1.5 cm.

Figure 2.

(a &b) Images showing that the terminal of the coronoid fragment was made visible during the surgery through an intraoral pre-ramus incision. (c) Before the fracture particle was removed, the passive mouth opening was recorded at 2.5 cm and (d) under general anaesthesia following successful surgical elimination of the fragmented coronoid process and achieving adequate haemostasis, the patient’s mouth was widened to 4 cm.

Figure 3.

(a) Postoperative cone beam computed tomographic (CT) image shows successful surgical elimination of the fragmented coronoid process. (b) A panoramic radiographic image shows that the fractured particle of the coronoid process has been eliminated successfully. (c) One-month post-surgery, the patient’s mouth was able to open to 2.5 cm and (d) after five months post-surgery, the patient’s mouth was able to open to 3 cm.