A Novel Approach to Coronoidectomy: the Modified Keen Technique

Coronoid fractures are relatively rare fractures of the craniofacial skeleton, but typically occur concomitantly with high-velocity craniofacial trauma to the midface and lateral mandible. Management of coronoid fractures may vary, but when surgical excision is indicated, treatment frequently involves an intraoral approach through a posterior intraoral incision along the mandibular ramus. Here, the authors present an alternative and novel approach to the coronoid process based on the Keen approach to the lateral midface.

The authors present a patient with a left zygomatico-maxillary complex fracture and left coronoid fracture. After disimpaction of the zygomatico-maxillary complex fracture, a maxillary vestibular incision in the gingivobuccal sulcus was made. After subperiosteal dissection, the maxillary fracture was exposed and fixated. A modified Keen approach was used to expose the coronoid process, perform temporalis myotomy, and excise the fracture fragment.

Compared to the classic intraoral approach to coronoidectomy, the modified Keen approach is a quick, versatile technique that allows for direct visualization of the coronoid process without the use of endoscopy, facilitates fixation of concurrent midfacial fractures, and utilizes an anterior intraoral incision that is easy to retract and close. For these reasons, the modified Keen technique for coronoidectomy should be considered in the treatment of trismus when an intraoral approach is indicated.