|Year : 2020 | Volume
| Issue : 2 | Page : 62-68
Coronoid Hyperplasia (Jacob’s Disease) as a Rare Cause of Restricted Mouth Opening: a Case Report
Mohammad Hasan Samandari1, Milad Etemadi Shalamzari1, Maryam Ghazizadeh2, Hooman Navaei3
1 Department of Oral and Maxillofacial Surgery, Dental Implant Research Center, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran
2 Department of Oral and Maxillofacial Radiology, School of Dentistry, Kermanshah University of Medical Science, Kermanshah, Iran
3 Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran
|Date of Submission||26-Jul-2019|
|Date of Decision||17-Dec-2019|
|Date of Acceptance||14-Feb-2020|
|Date of Web Publication||10-Jun-2020|
Assistant Professor Maryam Ghazizadeh
Department of Oral and Maxillofacial Radiology, School of Dentistry, Kermanshah University of Medical sciences, Kermanshah
Source of Support: None, Conflict of Interest: None
Introduction: Restricted mouth opening (MO) is associated with the problems in intra/extra-articular components such as trauma to the articular bone component especially at the early ages, chronic displacement of the articular disk, tumors, condylar anomalies, coronoid hyperplasia and hyperactivity of jaw muscles. A pseudo-joint can form between the zygoma and the hyperplastic coronoid process (Jacob’s disease). Pseudo-joint restricts MO, it causes multiple problems for patients, and finally it decreases the quality of their or patients’ lives. Therefore, early diagnosis and treatment are very important. Case Report: Described here is a 28-year-old man that due to trauma in childhood, his coronoid process became hyperplastic. The pseudo-joint formed between coronoid process and zygomatic bone interfere with MO. Discussion: The intraoral approach offers direct access without the risk of facial nerve injury or scars on the face
Keywords: Coronoid hyperplasia, jacob’s disease, temporomandibular joint
|How to cite this article:|
Samandari MH, Shalamzari ME, Ghazizadeh M, Navaei H. Coronoid Hyperplasia (Jacob’s Disease) as a Rare Cause of Restricted Mouth Opening: a Case Report. Dent Hypotheses 2020;11:62-8
|How to cite this URL:|
Samandari MH, Shalamzari ME, Ghazizadeh M, Navaei H. Coronoid Hyperplasia (Jacob’s Disease) as a Rare Cause of Restricted Mouth Opening: a Case Report. Dent Hypotheses [serial online] 2020 [cited 2021 Jan 18];11:62-8. Available from: http://www.dentalhypotheses.com/text.asp?2020/11/2/62/286350
| Introduction|| |
Growth and development of the temporomandibular joint (TMJ) depends on the full development of the mandible. Although TMJ is one of the most common sites for traumatic injuries, it is usually disregarded during the checkup. Unilateral trauma to the condyle and coronoid during the early ages of life leads to the mouth opening restriction and facial asymmetry in adulthood.
One of the reasons for restricted mouth opening (MO) is an abnormal increase in the length of coronoid. The long coronoid interferes with the medial or temporal surface of the zygomatic bone which decreases the infratemporal space. This space is required for mandibular rotation and translation. Therefore, MO and lateral movements are restricted., Coronoid hyperplasia was first described in 1835 by Von Langenback and was published in 1963 by Row. He described it as an abnormal process of coronoid then categorized it into two types of developmental or tumoral. The developmental type is usually bilateral while the tumoral type is usually unilateral. French anatomist Jacob reported the first case of Jacob disease in 1989 forming a pseudo-joint between the coronoid process and the zygomatic arch.
This report presents a case of Jacob’s disease as a consequence of trauma, which caused limitation in mouth opening.
| Case Report|| |
A 28-year-old man suffering from joint pain during mouth opening referred to the Oral and Maxillofacial Surgery Department of Isfahan University of Medical Sciences. The patient had no history of using drugs, alcohol, tobacco or cigarette. The patient reported a jaw trauma at the age of 10. Clinical examination didn’t show any obvious facial asymmetry. Maximal interincisal distance was 25 mm [Figure 1]. Temporomandibular joint examination did not report any tenderness or joint click.
Then panoramic radiography and CT scan with 3D reconstruction were obtained. On the images, there was an elongation of the left coronoid process, and an opaque mass at the tip of the coronoid was observed [Figure 2]. The opaque mass had the typical mushroom-shaped appearance extended to the left of the zygomatic arch root, and they were very close together.
|Figure 2 Patient’s panoramic radiography (high) and CT scan (low). Arrow in all the images shows the bony process.|
Click here to view
Regarding the MO limitation and the need to receive dental services, the surgical operation was done. Due to the MO limitation, the patient’s intubation was done through the nose using fiber optic. The patient’s anesthesia was performed by injecting Midazolam, Fentanyl, Nasonal, Morphine and Atracurium.
After palpation of the hyperplastic coronoid process intraorally, an intra-oral incision of size 2-cm was performed to achieve the coronoid region. The coronoid was completely exposed by removing mucosal tissue, muscle and periosteum [Figure 3]. Two weeks after surgery, the MO limitation was improved, and there was not any special problem for the patient.
| Discussion|| |
A literature review revealed that 62 cases of Jacob’s disease (20 female and 42 male) have been reported since 1943 [Table 1].,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, In the reported cases, the patients aged in the range of 5–73 with an average of 30 years. The majority of patients were diagnosed before the age of 30.
The average of maximum MO was 0–25 mm. Among reported cases, eight cases were bilateral and the rest of them were unilateral. 19 cases were treated by extraoral surgery method, 29 cases were treated by intraoral surgery method and five cases were treated by applying both methods. Only one case was treated by the method called Sphenopalatine ganglion block. Physiotherapy has an important role in preventing relapse of the condition. However, one relapsed case was reported. Since 1984, computed tomography has been used to diagnose the Jacob’s disease, and gradually the combination of two radiography methods (panoramic and CT) played an important role in diagnosing of that. After exploring the literature, we found the present case is the first reported Jacob’s disease from Iranian population.
Coronoid hyperplasia restricts anterior and posterior movements of the mandibular condyle. There are different theories explaining the causes of coronoid hyperplasia, such as trauma, hyperactivity of temporal muscle, hormonal stimulus and genetic. This excessive growth of the coronoid leads to the mandible movement restriction due to the compression of the coronoid appendage to the zygomatic bone.
Jacob’s disease is a rare condition of pseudo-joint formation between hyperplastic coronoid and the internal side of the zygomatic bone. Patients with Jacob’s disease usually have a painless progressive reduction in MO.,, All of the signs related to this disease are similar to the coronoid hyperplasia that involves advanced and asymptomatic limitation of mouth opening without occlusion abnormality. Therefore, these two disorders must be distinguished.
Although the radiological diagnosis might seem simple, because of very few numbers of existed cases, coronoid hyperplasia and Jacob’s disease are usually ignored by the clinician. Although panoramic image is adequate for diagnosing, it only creates a two-dimensional image. Three-dimensional CT (3DCT) can reconstruct images in coronal, sagittal and oblique planes. ,,, Levandoski analysis is usually used for diagnosing coronoid hyperplasia. in panoramic images. In this analysis, a line is drawn from the lowest part of mandibular angle to the highest limit of mandibular condyle and top of the coronoid. The height of normal coronoid is shorter than condyle (between 12 and 13 mm) but in hyperplastic size, it is more than 20 mm.
Treatment of Jacob’s disease is done by surgery with prolonged Physiotherapy especially in cases of MO limitation. The standard surgical treatment removes coronoid-zygoma interference by coronoidectomy with the intraoral approach. However, coronal and submandibular approaches have been used. Torre et al., reported a 16-year-old boy with Jacob disease. In their case, due to lack of compliance with physiotherapy, MO limited to 25 mm 4 months after intraoral coronoidectomy. Zarembinski et al, reported a case with cluster headache and temporal muscle tenderness because of bilateral coronoid hyperplasia with pseudo-joint. it was temporary treated by Sphenopalatine ganglion block and injection of 1 mL of 0.25% bupivacaine and 1 mL of dexamethasone (10 mg/mL). The intraoral approach offers direct access without the risk of facial nerve injury or scars on the face, but if the exostosis is bulbous and large, an extraoral approach may be necessary.,,
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Sheikhi M, Ghazizadeh M, Salehi MM. Posttraumatic mandibular asymmetry presenting in a young adult. Radiol Case Rep 2017;12:73-7.
Torenek K, Duman SB, Bayrakdar IS, Miloglu O. Clinical and radiological findings of a bilateral coronoid hyperplasia case. Eur J Dent 2015;9:149.
] [Full text]
Jenkins S, Smart K, Mustafa S, Evans R. Bilateral mandibular coronoid hyperplasia causing trismus-a case report. Oral Surg 2016;9:227-33.
Cisneros AV, Villasana EM, Ibáñez EV. Bilateral hyperplasia of the coronoid process.Clinical case report with unusual presentation and literary review. J Oral Res 2018;7:373-7.
Jacob O. A rare cause for continued constriction of the jaws. Bull Mem Societe Anat Paris 1899;1:917.
Shackelford RT, Brown WH. Osteochondroma of the coronoid process of the mandible. Surg Gynecol Obstet 1943;77:51-4.
Shackelford RT, Brown WH. Restricted jaw motion due to osteochon droma of the coronoid process. J Bone Joint Surg Am 1949;31:107-14.
Brandt K. Deformation congenitale de l’apophyse coronoide du maxillaire. Acta Orthop Scand 1943;14:219-1219.
Brailsford JF. An unusual osteochondroma from the coronoid process of the mandible. Br J Radiol 1952;25:555-6
Holmes FH. Mandibular block by osteochondroma of the coronoid processes. Radiology 1956:67:578-81.
Levine MH, Chessen J, Mc Carthy WD. Osteochondroma of the coronoid process of the mandible: report of a case and review of literature. N Engl J Med 1957:257:374-6.
Dingman RO, Natvig P. Reduced mandibular motion due to osteochondroma of the coronoid process of the mandible. Am J Surg 1957;94:907-10.
Antoni AA, Brown A, Johnson JH. Osteochondroma of the coronoid process of the mandible: report of case. J Oral Surg 1958;16:514-7.
Pap G, Friedman E. Restricted mandibular movements due to osteochondroma of the coronoid process. Br J Plast Surg 1958;11:169-73.
Lebo CP. Osteochondroma of the mandibular coronoid process: report of a case and review of literature. Laryngoscope 1961;71:814-22.
Mohnac AM. Bilateral coronoid osteochondromas. J Oral Surg 1962;20:500–6.
Allan IM, Reid WH. Unilateral exostosis of the coronoid process of the mandible. Br J Oral Surg 1967; 5:20-4.
Meyer RA. Osteochondroma of coronoid process of mandible: report of case. J Oral Surg 1972; 30:297-300.
James RB, Alexander RW, Traver Jr. Osteochondroma of the mandibular coronoid process: report of a case. Oral Surg Oral Med Oral Pathol 1974;37:189-95.
Cooper JC, Finch LD. Coronoid osteochondroma presenting as a coronozygomatic ankylosis: a case report. Br J Oral Surg 1974;137:99-102.
Takeda S, Osanai K, Morita T, Kiwada S, Takizawa T. Osteochondroma of left coronoid process followed by extremely restricted mandibular movement: report of a case (in Japanese). Jpn J Oral Maxillofac Surg 1975;21:580-6.
Singer R, Schulz P. Eingeschrankte Mundöffnung durch hyperplasie oder Osteochondrom des Processus coronoideus. Literaturubersicht ZWR 1976;85:685-90.
Ramon Y, Horowitz I, Oberman M, Freedman A, Tadmor R. Osteochondroma of the coronoid process of the mandible. Oral Surg Oral Med Oral Pathol 1977;43:692-7.
Ito N, Otsu T, Fujioka Y, Takeda Y, Suzuki A. Osteochondroma of the coronoid process of the mandible: report of a case and review of literature. Jpn J Oral Maxillofac Surg 1981;27:863-76 [in Japanese].
Ishii J, Amagasa T, Akashi K, Shioda S, Yuki K. Restricted jaw movement due to osteochondroma of the mandibular coronoid process: report of two cases. Jpn J Oral Maxillofac Surg 1983:29:507-13 [in Japanese].
Revington PJ. “Turret exostosis” of the coronoid process. Br J Oral Maxillofac Surg 1984;22:37-41.
Tucker MR, Guilford WB, Howard CW. Coronoid process hyperplasia causing restricted opening and facial asymmetry. Oral Surg Oral Med Oral Pathol 1984;58:130-2.
Schwartz HC, Liebel DP. Use of a hemicoronal scalp flap to approach an osteochondroma of the coronoid process. J Oral Maxillofac Surg 1987;45:545-1545.
Macleod AWG. Limitation of mandibular opening due to enlarged coronoid processes. Aust Dent J 1987;32:120-5.
Totsuka Y, Fukuda H, Iizuka T, Shindoh M, Amemiya A. Review osteochondroma of the coronoid process of the mandible.Report of a case showing histological evidence of neoplasia. J Craniomaxillofac Surg 1990;18:27-32.
Asanami S, Kasazaki Y, Uchida I. Large exostosis of the mandibular coronoid process: report of a case. Oral Surg Oral Med Oral Pathol 1990;69:559-62.
Kerscher A, Piette E, Tideman H, Wu PC. Osteochondroma of the coronoid process of the mandible.Report of a case and review of the literature. Oral Surg Oral Med Oral Pathol 1993;75:559-64.
Constantinides M, Lagmay V, Miller P. Coronoid osteochondroma of the mandible: transzygomatic access and autogenous bony reconstruction. Otolaryngol Head Neck Surg 1997;117:S86-S91.
Chen PK, Chang SC, Huang F, Chen YR, Yeow VK, Williams WG. Transzygomatic coronoidectomy through an extended coronal incision for treatment of trismus due to an osteochondroma of the coronoid process of the mandible. Ann Plast Surg 1998;41:425-9.
Maganaro A. Osteochondroma of the coronoid process. Gen Dent 1998;46:92-4.
Chichareon V, Arpornmaeklong P, Donsakul N. Fibrodysplasia ossificans progressiva and associated osteochondroma of the coronoid process in a child. Plast Reconstr Surg 1999;103:1238-43.
Hernandez-Alfaro F, Escuder O, Marco V. Joint formation between an osteochondroma of the coronoid process and the zygomatic arch (Jacob disease): report of case and review of literature. J Oral Maxillofac Surg 2000;58:227-32.
i de la Torre ÒE, Klok EV, i Roig AM, Mommaerts MY, i Ayats JP. Jacob’s disease: report of two cases and review of the literature. J Cranio-Maxillofac Surg 2001;29:372-6.
Escuder i de la Torre O, Vert Klok E, Mari i Roig A, Mommaerts MY, Pericot i Ayats J. Jacob’s disease: report of two cases and review of the literature. J Craniomaxillofac Surg 2001;29:372-6.
Roychoudhury A, Gupta Y, Parkash H, Karak AK. Jacob disease: report of a case and review of the literature. J Oral Maxillofac Surg 2002;60:699-703.
Dede U, Tuzuner AM, Kisnisci RS. Osteochondroma of coronoid process: Jacob’s disease. Int J Oral Maxillofac Surg 2007;36:1101.
Thota G, Cillo JE, Krajekian J, Dattilo DJ. Bilateral pseudojoints of the coronoid process (Jacob disease): report of a case and review of the literature. J Oral Maxillofac Surg 2009;67:2521-4.
Zhong SC, Xu ZJ, Zhang ZG, Zheng YH, Li TX, Su K. Bilateral coronoidhyperplasia (Jacob disease on right and elongation on left): report of a case and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e64-e67.
Yesildag A, Yariktas M, Doner F, Aydin G, Munduz M, Topal U. Osteochondroma of the coronoid process and joint formation with zygomatic arch (Jacob disease): report of a case. Eur J Dent 2010;4:91.
Coll-Anglada M, Acero-Sanz J, Vila-Masana I, Navarro-Cuéllar C. Jacob’s disease secondary to coronoid process osteochondroma. Med Oral Patol Oral Cir Bucal 2011;16:e708.
Sreeramaneni SK, Chakravarthi P, Prasad LK, Satish PR, Beeram RK. Jacob’s disease: report of a rare case and literature review. Int J Oral Maxillofac Surg 2011;40:753-7.
Ajila V, Hegde S, Gopakumar R, Babu GS. Imaging and histopathological features of Jacob’s disease: a case study. Head Neck Pathol 2012;6:51-3.
Choi JG, Kim SY, Perez-Atayde AR, Padwa BL. Bilateral coronoid process hyperplasia with pseudocartilaginous joint formation: Jacob disease. J Oral Maxillofac Surg 2013;71:316-21.
Stringer DE, Chatelain KB, Tandon R. Surgical treatment of Jacob’s disease: a case report involving an osteochondroma of the coronoid process. Case Rep Surg 2013;2013.
Aoki N, Okamura K, Niino D, Iwamoto O, Kusukawa J. Osteochondroma of the right coronoid process (Jacob disease): a case report. CRANIO® 2013;31:66-9.
Hosein MM, Eng F, RCSE F, Ire FR. Osteochondromatosis and the coronoid-zygomatic pseudojoint (Jacob’s disease) as an unusual cause of midfacial asymmetry and jaw restriction. Pakistan Oral Dent J 2013;33.
Jha A, Gupta P, Khalid M, Naseem I, Gupta G. Sarcomatous transformation of osteochondroma of the coronoid process forming pseudoarthrosis with zygomatic arch mistaken for Jacob disease. J Craniofac Surg 2014;25:e101-e2.
Losa-Muñoz PM, Burgueño-García M, González-Martín-Moro J, Sánchez-Burgos R. Osteochondroma of coronoid process: a rare etiology of Jacob disease. Craniomaxillofacial Trauma & Reconstruction 2014;7:306-9.
Zarembinski C, Graff-Radford S. An unusual challenge in performing sphenopalatine ganglion block with enlarged coronoid process: Jacob’s disease. Pain Med 2014;15:329-32.
Sinha SK, Kumar S. Osteochondroma of coronoid process and joint formation with zygomatic arch (jacob disease): a rare case report. Int J Sci Study 2014;1:63-5.
Rahim I, Balasundaram I, Kanzaria A, Kane S, Bridle C. Jacob’s disease: an exceedingly rare cause of limited mouth opening. Br J Oral Maxillofac Surg 2014;52:e113.
Reddy NVV, Rajan R, Rachalapally VK, Kallam SR. Jacob’s disease: a rare case report. Journal of Dr NTR University of Health Sciences 2014;3:202.
Robiony M, Casadei M, Scott CA, Chiarini L. Progressive limitation in mouth opening: Jacob disease. J Craniofac Surg 2016;27:821.
Shin D-W, Kim J-E, Kim H-S, Lee H. Jacob’s disease: Report of a case. CRANIO® 2017;35:58-63.
Imen C, Zouha M, Ahmed Z, Dorra C, Habib K, Touhami BA. Clinical and radiological features of Jacob’s disease.A case report involving an osteochondroma of the coronoid process. Médecine Buccale Chirurgie Buccale 2016;22:145-9.
Roscher D, Attaguile A, Benitez J, Giannunzio G. Jacob’s disease: a case report and literature review. Dentistry 2018;8:2161-1122.1000485.
Ghazizadeh M, Sheikhi M, Salehi MM, Khaleghi A. Bilateral coronoid hyperplasia causing painless limitation of mandibular movement. Radiol Case Rep 2018;13:112-7.
Bayar GR, Akcam T, Gulses A, Sencimen M, Gunhan O. An excessive coronoid hyperplasia with suspected traumatic etiology resulting in mandibular hypomobility. CRANIO® 2012;30:144-9.
Rowe NL. Bilateral developmental hyperplasia of the mandibular coronoid process.A report of two cases. Br J Oral Surg 1963;1:90-104.
Ozkaya O, Colak O, Sutcu M, Akan M. The outcome of coronoidectomy in bilateral coronoid process hyperplasia. CRANIO® 2018;36:53-60.
Kubota Y, Takenoshita Y, Takamori K, Kanamoto M, Shirasuna K. Levandoski panographic analysis in the diagnosis of hyperplasia of the coronoid process. Br J Oral Maxillofac Surg 1999;37:409-11.
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