We would like to comment on the article: “Wedge subcoronoid ostectomy: an alternative to coronoidotomy. Int J Oral Maxillofac Surg 2010;39(November (11)):1127–9, Prabhu S, et al .
As our work is cited in this article , we would like to make a few comments.
The problem of re-ankylosis in those operated patients seems to be immanent. Although there seems to be scarce data about the coincidence of ectopic bone formation, particularly in patients showing coronoid hyperplasia, one should be aware, that this approach bears the potential of re-ankylosis due to ectopic bone formation in the operative field.
The authors do not state on how future re-ankylosis will be prevented at the gap osteotomy site. Based on the orthopantomograph, we cannot determine if there was placement of interpositional material within the gap osteotomy area of the right TMJ. However, we must assume that re-ankylosis of the right TMJ was prevented by the interposition of local tissue. Many interpositional techniques, including the use of temporary or permanent alloplastic spacers or alloplastic total joint replacement have been proposed for minimizing this risk.
Concerning the wedge technique, we see a similar risk of bony reformation within the gap and consecutively re-ankylosis, if parts of the coronoid process remain in situ . When intraoral removal of the process seems technically difficult, we would recommend an endoscopically assisted transoral approach or an extraoral access , or the combination of both of them.
Apart from that it is seems important to consider that one stage bilateral removal of the coronoid process might lead to severe malocclusion by mandibular protrusion, which could be combined with an anterior open bite .