Bilateral hyperplasia of the Coronoid process in pediatric patients: what in the Gold Standard for treatment? A systematic review of the literature

Aim: To describe the therapeutic options for bilateral coronoid process hyperplasia in pediatric patients, analysing etiological and diagnostic correlations and evaluating long-term outcomes, in order to identify the gold standard treatment. Materials and methods: A systematic review wa conducted according to PRISMA guidelines using Medline, PubMed, Embase and the Cochrane Library up to December 5, 2017. Clinical studies, care reports, and reviews concerning pediatric patients were included. After removal of duplicates and application of inclusion and exclusion criteria, 38 articles were selected for qualitative synthesis. Extracted data included demographic characteristics, type of treatment (intraoral/extraoral coronoidectomy, coronoidotomy, physiotherapy), pre and post operative mouth opening and follow-up. Results and conclusions: Bilateral coronoid process hyperplasia results in progressive limitation of mouth opening (<20mm9, compromising craniofacial growth and stomatognathic function. Surgical treatment led to a post-operative increase in mouth opening (ranging from 5 to 25mm), with more favorable outcomes for intraoral coronoidectomy combined with early and intensive rehabilitation. However, only a proportion of patients achieved and maintained mouth opening values considered physiological (>30mm), particularly in the absence of adequate physiotherapy or in patients treated during growth. Early diagnosis is essential, and CBCT represents the gold standard for ddiagnosis. The treatment of choice is coronoidectomy, preferably via an intraoral approach, combined with rehabilitation. Limitations were identified due to the limited availability in the literature of longitudinal studies with long-term follow-up for assessment of treatment stability over time.