title: Successful Treatment of Postoperative Mouth Opening Limitation Following Le Fort III Distraction with Bilateral Coronoidectomies.
abstract: BACKGROUND
  Distraction osteogenesis is a powerful tool in craniomaxillofacial surgery, allowing for large advancements of osteotomized segments in the setting of a restrictive soft tissue envelope. Despite its benefits, distraction can have negative functional consequences. We present a case of a patient with Crouzon syndrome who developed reduced mouth opening capability after a Le Fort III midfacial advancement with rigid external distraction.
  
  
  METHODS
  Radiographic evaluation revealed that the coronoid process was restricting the normal excursion of the mandible by contacting the posterior zygoma. The patient was subsequently treated with a bilateral coronoidectomy via an intraoral approach, which improved his interincisal opening. Maximum interincisal distance was improved from 18 mm to 33 mm following bilateral cornoid resection.
  
  
  CONCLUSIONS
  We report coronoid impingement as a potential complication after Le Fort III distraction. Such a finding suggests the need for a detailed vector analysis in cases undergoing midface advancement with distraction. Post-distraction coronoidectomy is a useful surgical procedure to treat mouth opening limitation due to coronoid impingement against the zygoma after midfacial advancement.
authors.affiliation: Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Greives
authors.affiliation: Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Figueroa
authors.affiliation: Bernard Sarnat Scholar of Craniofacial Research, Section of Plastic Surgery, The University of Chicago Medicine and Biological Sciences, 5481 S. Maryland Ave., Room J-641, MC 6035, Chicago, IL 60637 USA.
authors.forename: Russell R
authors.initials: RR
authors.lastname: Reid
keywords: Coronoidectomy; Le Fort III distraction; Limited opening ability