Trismus caused by a combination of bilateral buccal contracture and coronoid process hyperplasia: Report of a unique case.

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In recent years, the incidence of noma-induced trismus has markedly decreased. Despite its infrequent occurrence, this condition often presents various difficult problems to the surgeons. In a 48-year-old male reported here, the presence of severe bilateral buccal contracture suggested this was the only cause of his trismus. However, after an advanced cicatricotomy followed by the grafting of four flaps of full thickness skin (6×4cm each), the improvement of jaw-opening was far from satisfactory. Careful postoperative analysis of CT and cephalographs disclosed that hyperplasia of both coronoid processes was partially responsible for the trismus. The hyperplasia most likely resulted from the longstanding trismus itself, and hence, was treated not by surgical intervention, but by active jaw-opening training. Such a functional training proved quite effective. Indeed, the interincisal distance, which measured only 28mm immediately after the cicatricotomy, increased to 44mm within a couple of months. After 11 months of follow-up, the patient retains a sufficient range of jaw-opening with satisfactory mastication by means of dentures that could not be worn previously.