Materials and methods

A systematic search in the Pubmed database was conducted to find related articles. In the search, the following Medical Subjects Headings (MeSH) terms were used: ‘coronoid’, ‘hyperplasia’, and ‘mandible’. The following free-text terms were entered as synonyms. For the term ‘coronoid’, synonyms ‘coronoid process’, ‘processus coronoideus’ and ‘processus muscularis’ were entered. For the term ‘hyperplasia’, synonyms ‘elongation’, ‘impingement’ and ‘enlargement’ were entered, as well as the MeSH term ‘hypertrophy’. For ‘mandible’, ‘mandib*’ and ‘lower jaw’ were entered as synonyms. Boolean operator OR was applied between synonyms. The operator AND was used between the three search terms.

The search was limited to articles in English describing cases, published in, or after, 1995. Titles and abstracts were assessed to select relevant articles, and then the full-text articles were retrieved. The reference lists of the selected articles were manually checked to trace additional cases. Throughout the search, cases were excluded if no hyperplasia with impingement was present, and/or histology and morphology of the coronoid process was characteristic for an osteochondroma.

From the included articles, specific case-characteristics were extracted and entered into a database as numerical or categorical data. Numerical data included age at diagnosis, duration of symptoms, maximum mouth opening (MMO) before, during and after the operation and length of follow-up. Categorical data consisted of uni- or bilateral CPH form, sex, diagnostic method, surgical method, and whether additional physiotherapy was performed. Two additional variables were calculated: age at onset and MMO improvement.

To evaluate if there was a statistically significant association between sex and uni- or bilateral type of CPH, a χ ² -test was performed. The authors carried out several statistical tests on the outcome data. They split the surgery types into two groups: coronoidectomy and coronoidotomy groups. Cases were filtered out that had an extra-oral approach or underwent additional masseter stripping to make the coronoidectomy group more homogenous. After testing normality of the distribution with a residuals histogram, an independent t test was done to compare the means of the preoperative MMO, final MMO and MMO difference. A univariate analysis of variance (UNIANCOVA) was performed on the final MMO with the preoperative MMO as covariate. Differences were considered to be significant if p < 0.05. Management of the database and statistical analyses were performed using SPSS for Windows version 17.0.

Results

The literature search was performed on 4 June 2010. The search led to 39 hits of which 35 articles were considered relevant. The full text of 5 articles could not be retrieved. With additional cross-referencing 5 relevant articles were found of which 4 were retrieved. Of the 34 articles that were assessed in full text, 8 articles were excluded. In two articles, no cases were described. Six articles reported cases which were excluded based on the exclusion criteria. One case was excluded from an article that reported two cases. From the selected articles, 58 cases were entered into the database. Information from the 3 cases at the authors’ institution was entered. 61 cases in total were analyzed ( Table 1 ).

Table 1

Case summaries.

	Authors	Year	Age (yrs)	History (yrs)	Type	Sex	Preoperative MMO (mm)	Peroperative MMO (mm)	Final MMO (mm)	Approach	Type	Follow-up (months)
1	Gibbons	1995	34	17	bi	M	19	35	NS	IO	Ectomy	NS
2	Loh et al.	1997	22	4	bi	M	5	NS	20	EO	Ectomy	4
3	Loh et al.	1997	41	NS	bi	M	15	25	25	IO	ectomy	4
4	Loh et al.	1997	25	10	bi	F	16	NS	30	IO	Ectomy	4
5	Loh et al.	1997	14	2	bi	M	13	22	37	IO	Ectomy	12
6	Gerbino et al.	1997	15	1	uni	M	15	NS	41	IO	Tomy	12
7	Gerbino et al.	1997	14	2	uni	M	12	NS	48	IO	Tomy	60
8	Gerbino et al.	1997	13	3	bi	M	18	NS	38	IO	Tomy	15
9	Gerbino et al.	1997	32	17	bi	M	20	NS	38	IO	Tomy	60
10	Gerbino et al.	1997	16	2	bi	M	20	NS	45	IO	Tomy	60
11	Yamaguchi et al.	1998	25	8	uni	M	24	NS	43	IO	Ectomy	18
12	Pregarz et al.	1998	17	NS	uni	M	18	28	35	IO	Ectomy	20
13	Pregarz et al.	1998	20	7	bi	M	13	20	27	IO	Ectomy	12
14	Pregarz et al.	1998	17	5	bi	M	17	NS	39	IO	Ectomy	12
15	Pregarz et al.	1998	15	5	bi	M	18	NS	40	IO	Ectomy	24
16	Pregarz et al.	1998	16	NS	bi	M	19	25	38	IO	Tomy	12
17	Kubota et al.	1999	23	NS	bi	F	NS	NS	NS	NS	NS	NS
18	Kubota et al.	1999	28	NS	bi	F	NS	NS	NS	NS	NS	NS
19	Kubota et al.	1999	61	NS	bi	M	NS	NS	NS	NS	NS	NS
20	Mavili et al.	1999	17	14	uni	M	22	48	45	Endo	Ectomy	8
21	Turk	1999	1	1	bi	M	8	NS	25	IO	Ectomy	4
22	Turk	1999	0	NS	bi	NS	10	NS	40	IO	Ectomy	NS
23	Asaumi et al.	2001	7	NS	bi	M	17	NS	NS	NS	NS	NS
24	Asaumi et al.	2001	14	NS	bi	M	2	NS	NS	NS	NS	NS
25	Leonardi	2001	14	NS	bi	M	25	NS	NS	NS	NS	NS
26	Colquhoun et al.	2002	26	3	bi	M	22	35	22	IO	Ectomy	30
27	Fabie et al.	2002	8	8	bi	F	6	33	30	IO	Ectomy	8
28	Mano et al.	2005	5	NS	bi	M	17	NS	40	IO	Ectomy	82
29	Tieghi et al.	2005	17	1	bi	F	25	40	40	IO	Ectomy	20
30	Tieghi et al.	2005	15	2	bi	M	25	40	46	IO	Ectomy	6
31	Satoh et al.	2006	13	1	bi	M	27	40	45	IO	Ectomy	8
32	Leovic et al.	2006	35	18	bi	M	15	NS	35	NS	Tomy	NS
33	Kursoglu and Capa	2006	17	NS	bi	M	14	NS	NS	None	None	NS
34	Kursoglu and Capa	2006	24	NS	bi	M	27	NS	NS	None	None	NS
35	Gibbons and Abulhoul	2007	36	20	bi	M	20	30	38	IO	Ectomy	12
36	Mazzetto et al.	2007	55	NS	uni	M	32	NS	NS	None	None	NS
37	Yoshida et al.	2008	34	NS	bi	F	18	44	38	IO	Ectomy	6
38	Ferro et al.	2008	28	NS	bi	M	13	NS	40	IO	Ectomy	12
39	Wenghoefer et al.	2008	53	NS	uni	F	NS	NS	30	NS	Ectomy	12–15
40	Wenghoefer et al.	2008	38	NS	uni	M	7	NS	35	NS	Ectomy	12–15
41	Wenghoefer et al.	2008	52	NS	uni	M	22	NS	NS	NS	Ectomy	12–15
42	Wenghoefer et al.	2008	18	NS	uni	F	NS	NS	30	NS	Ectomy	12–15
43	Wenghoefer et al.	2008	4	NS	bi	M	NS	NS	30	NS	Ectomy	12–15
44	Wenghoefer et al.	2008	28	NS	bi	M	NS	NS	30	NS	Ectomy	12–15
45	Wenghoefer et al.	2008	56	NS	bi	M	25	NS	NS	NS	Ectomy	12–15
46	Wenghoefer et al.	2008	23	NS	bi	M	10	NS	23	NS	Ectomy	12–15
47	Wenghoefer et al.	2008	2	NS	bi	F	10	NS	25	NS	Ectomy	12–15
48	Wenghoefer et al.	2008	18	NS	bi	M	16	NS	30	NS	Ectomy	12–15
49	Wenghoefer et al.	2008	35	NS	bi	M	5	NS	31	NS	Ectomy	12–15
50	Wenghoefer et al.	2008	45	NS	bi	M	10	NS	31	NS	Ectomy	12–15
51	Wenghoefer et al.	2008	5	NS	bi	F	4	NS	32	NS	Ectomy	12–15
52	Wenghoefer et al.	2008	14	NS	bi	M	15	NS	33	NS	Ectomy	12–15
53	Wenghoefer et al.	2008	16	NS	bi	M	14	NS	40	NS	Ectomy	12–15
54	Wenghoefer et al.	2008	24	NS	bi	M	18	NS	40	NS	Ectomy	12–15
55	Zhong et al.	2009	39	13	uni	F	8	40	31	IO	Ectomy	9
56	Yura et al.	2009	28	13	uni	M	30	50	43	IO	Tomy	15
57	Baraldi et al.	2010	20	NS	uni	F	12	30	35	IO	Ectomy	8
58	Galie et al.	2010	3	2	uni	F	5	NS	35	EO	Ectomy	18
59	The authors’ patient	2010	41	6	bi	F	15	25	22	IO	Ectomy	16
60	The authors’ patient	2010	14	2	bi	M	6	40	30	IO	Ectomy	4
61	The authors’ patient	2010	29	14	bi	M	20	40	39	IO	Ectomy	5

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