The girl was unable to open her mouth due to which she could not eat or chew food and had difficulty in speech
Ear infection – a primary cause for the obstruction in opening of mouth
Kauvery Hospital Chennai, a unit of Kauvery Group of Hospitals, a leading multispecialty healthcare chain in Tamil Nadu, today announced the successful treatment of a child with the inability to open her mouth.
The girl aged eight years, from Tirunelveli, was brought to the hospital with complaints of inability to open her mouth. The child, who developed early stages of Temporomandibular Joint Ankylosis (a condition where the mandible (lower jaw bone) is fused to the fossa (a hollow space) by bony or fibrotic tissues), could open her mouth only up to 1mm.
Dr. Manikandan Ramanathan, Oral and Maxillofacial Surgeon, Kauvery Hospital Chennai, said, “The young girl came to us with an inability to open her mouth, a problem she had been facing for the previous three to four years. We thoroughly examined the child and inquired into the possible causes for this serious disability and discomfort. We speculated whether it was due to an injury from a fall that might have damaged the joint or a possible chronic ear infection. The parents confirmed that she did not have any major injuries but had a history of ear infection, and that a surgery was done for the same. It was after this surgery that she was unable to open her mouth.”
When treatment is not given at the right time for such problems, the damaged joint would get fused, leading to such complications. CT scans and MRI showed that the right side temporomandibular joint (jaw) was indeed completely fused with the rest of her skull.
“We then proceeded to make a model of the child’s head based on the CT Scans that we took. Accordingly, we planned how to tackle the complexities, and perform the surgery using the head model. This particular procedure is called Stereolithographic model.
After designing a detailed plan, we put the girl under Anaesthesia. This was a complicated procedure as it required the patient to open her mouth to undergo the intubation that was required to maintain the anesthetized state. We opted to use a procedure called Fiberoptic Bronchoscopy to intubate the child and put her under Anesthesia. (Fiberoptic Bronchoscopy is a procedure that allows the doctor to examine the breathing passages (airways) of the lungs of the patient). We were then able to perform the surgery where we removed the bone mass which restricted the opening of the mouth and placed a growing joint from the chest rib in the operated region,” he added.
Within two days of surgery the girl regained her ability to open her mouth to almost 30mm. She has since regained good opening of mouth which facilitates normal speech and has been able to perform all functions like eating and chewing solid food, which was a huge challenge earlier when she could only ingest fluids and mashed food.
“Infections causing conditions such as these are very common in young children due to their inability to keep the region clean. Also, the distance between the joint of the jaw and the ear is very short so any infection in either region can easily spread to the other. This has been the primary reason for the child’s inability to open her mouth, which further led to Temporomandibular Joint Ankylosis. This, if left untreated, could have led to life-threatening problems such as choking, or aspiration into her lungs causing pneumonia or led to permanent damage to the jaw’s growth. We were able to treat the child at the right time and restore the functions of her jaw. She would need regular monitoring for the next eighteen years as growth continues to take place actively,” added Dr. Manikandan.
Commenting on the success of the treatment, Dr. Aravindan Selvaraj, Co-founder & Executive Director, Kauvery Hospital, Chennai, said, “This case is a reminder for parents to be wary of any unusual signs in their child’s growth. When a child has a fall and sustains an injury, or undergoes an infection in an organ system it is best to have it checked completely to avoid complications such as these. We came to know that the child was not able to undergo the required treatment due to the risk involved in administering anaesthesia for surgery. The state-of-the-art infrastructure and modern technologies like Fiberoptic Bronchoscopy at our hospital, were keys to achieving such an excellent and happy outcome for the child and family. I congratulate Dr. Manikandan and team for helping the child regain the normal functions of her jaw thereby enabling her to lead a better quality of life.”