Management of unilateral temporomandibular joint ankylosis with facial asymmetry

Abstract

Long-standing temporomandibular joint (TMJ) ankylosis may compromise facial form and function. Treatment planning needs to address both the ankylosis and the facial deformity. A 21-year-old male patient with unilateral TMJ ankylosis of the right side with gross facial asymmetry was planned for a two-stage surgical procedure. First-stage surgery was done to release fibrous ankylosis, create a new functional joint and achieve adequate mouth opening. A vertical ramus osteotomy with superior repositioning of the proximal ramal segment and interpositional temporalis myofascial flap was done to achieve a functional joint and correct the facial height discrepancy. As the mouth opening was <35 mm, ipsilateral coronoidectomy was done and the resected coronoid process was used a graft in the mandibular angle region. 35 mm of mouth opening was achieved intraoperatively.