Limitation in mouth opening after craniotomy: a case report

A case of severely limited mouth opening after craniotomy is reported. A 48-year-old woman wasreferred to our department for treatment of limited mouth opening. She had a medical history of a subtemporaland a lateral suboccipital craniotomy, with decreased mouth opening developing a month after the cranial surgery.The maximum inter-incisal distance was 7 mm, and no movement of the left temporomandibular joint wasdetected. Radiographic images revealed hyperplasia of the left mandibular head and lack of interarticular space.We planned treatment in 3 stages: initial operation (gap arthroplasty and insertion of an artificial membrane), physiotherapy after the operation, and secondary surgery (elimination of the membrane).During the initial surgery, maximum opening of the mouth increased from 7 mm to 21 mm, but muscle contracturewas suspected to prevent further improvement. Therefore, coronoidectomy and removal of the masseter musclewere performed additionally. These procedures increased maximum opening to 47 mm.She started mouth-opening exercises with a gag on the next day. The range of active motion increased from 22mm to 35 mm. After discharge from our hospital, she continued home rehabilitation.Secondary surgery was performed 3 months after the initial surgery. She continued the same exercises, withless pain. Maximum opening of 41 mm has been maintained for 7 months after the initial surgery.