case_images: PMC11340843_01
case_images: Pre-operative active mouth opening (21 mm)
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case_images: TMJ examination revealed bilateral pre-auricular tenderness and pain, limited active mouth opening of 21 mm [Figure 1], limited excursion movements, slight deflection to the right side on mouth opening and no clicking or crepitation sounds were detected.
case_images: Pre-operative magnetic resonance imaging proton density; (a) closed temporomandibular joint (TMJ) right side, (b) open TMJ right side, (c) closed TMJ left side, (d) open TMJ left side
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case_images: Magnetic resonance imaging (MRI) for both TMJ showed, bilateral non-reducible PDD, associated with disc thickening and osteophytes [Figure 2].
case_images: Root of helix inter tragus notch incision; (a) incision marking, (b) temporomandibular joint field exposure via incision
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case_images: The incision was marked slightly inward starting from the intratragic notch, tragus and crus of helix continuing inward and upwards with the helix [Figure 3a]. Exposure of TMJ was achieved after dissection [Figure 3b], followed by releasing and mobilising the disc.
case_images: (a) Immediate post-operative passive mouth opening (42 mm), (b) active mouth opening post-operatively (39 mm)
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case_images: Immediate post-operative passive mouth opening increased to 42 mm [Figure 4a]. The patient was reviewed after 1 month, 3 and 6 months postoperatively, and outcomes remained stable regarding the active mouth opening (39 mm) without pain [Figure 4b], in addition, the cosmetic result of RHITNI [Figure 5].
case_images: (a) Closure, (b) 1 month post-operatively of root of helix inter tragus notch incision (RHITNI) approach at left side, (c) 1 month post-operatively of RHITNI approach at right side
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case_images: The patient was reviewed after 1 month, 3 and 6 months postoperatively, and outcomes remained stable regarding the active mouth opening (39 mm) without pain [Figure 4b], in addition, the cosmetic result of RHITNI [Figure 5].
case_images: Nine months post-operative magnetic resonance imaging; (a) open temporomandibular joint (TMJ) right side, (b) open TMJ left side
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case_images: MRI for both TMJs after 9 months revealed good disc reposition during mouth opening, which explains mouth opening improvement [Figure 6].