Oral Submucous Fibrosis (OSMF) with temporomandibular joint ankylosis presents significant challenges to airway management due to restricted mouth opening and fibrosis involving the oropharyngeal tissues. The situation becomes more critical in emergency surgeries with a full stomach, where the risk of aspiration further complicates airway planning. This was a case of a 56-year-old female with known OSMF and restricted mouth opening posted for emergency laparotomy due to a faecal fistula formation at the laparoscopic cholecystectomy port site. Given the anticipated difficult airway and full-stomach status, Awake Fibreoptic Intubation (AFOI) was planned and successfully executed. Awake fibreoptic intubation remains the gold standard in managing anticipated difficult airways, especially when complicated by additional risks like upper airway tumours or infections, cervical spine instability, congenital facial abnormalities, previous difficult intubation, and emergency conditions involving a full stomach where aspiration risk is high. This case reinforced its value in ensuring patient safety in emergency surgical scenarios.

Background Temporomandibular joint disorders can severely impair mandibular function, aesthetics, and quality of life. When conservative management fails, temporomandibular joint replacement with patient-specific, custom-made prostheses provides a reliable surgical solution. However, the success of such interventions depends not only on surgical precision but also on comprehensive prehabilitation and rehabilitation. Objective This study presents a case series highlighting the critical role of individualized rehabilitation in optimizing outcomes after temporomandibular joint replacement. Materials and methods Three patients with advanced temporomandibular joint pathology, a comminuted condylar fracture, bilateral temporomandibular joint ankylosis, and mandibular ameloblastoma, underwent reconstruction with custom implants. Each patient participated in a structured prehabilitation program, including physiotherapy, laser therapy, and myofascial release, followed by an individualized postoperative rehabilitation protocol. Results All patients achieved significant functional recovery, including improved mandibular mobility, mastication, swallowing, and speech, as well as complete pain resolution and restoration of facial symmetry. The multidisciplinary rehabilitation approach was instrumental in accelerating recovery and enhancing quality of life. Conclusion Temporomandibular joint replacement with custom-made prostheses, combined with a protocol-driven prehabilitation and rehabilitation program, ensures optimal functional and aesthetic outcomes. This case series emphasizes that rehabilitation is not an adjunct but an essential, integral component of successful temporomandibular joint reconstruction.

This study aimed to determine the proportion of cats referred for suspected temporomandibular joint (TMJ) luxation that were confirmed as true cases and to identify their final diagnoses. The objective was to highlight potential differential diagnoses to improve diagnostic accuracy and case management. A total of 42 cats that were referred to our hospital for suspected TMJ luxation as a chief complaint from April 2020 to February 2025 were included in the study. According to owner reports, these patients commonly exhibited an inability to close the mouth, apparent mandibular deviation, and, in most cases, signs suggestive of oral pain. Of the 42 cats studied, only 6 had isolated TMJ luxation. The rest had other diagnoses: 19 with end-stage periodontal disease, 5 with malocclusion, 4 with symphyseal separation, and 3 with open-mouth jaw locking resulting from other causes. Two had mandibular fractures, 2 had no significant findings, and 1 had TMJ ankylosis. End-stage periodontal disease was the most common diagnosis among cats referred for suspected TMJ luxation. Other final diagnoses included TMJ luxation, malocclusion, fractures, mandibular symphyseal instability, open-mouth jaw locking resulting from other causes, and TMJ ankylosis. Diagnosis is challenging due to nonspecific signs that mimic other oral diseases and are often linked to complex maxillofacial injuries, requiring thorough exams and advanced imaging. This study emphasizes the importance of considering differential diagnoses in cats presenting with signs resembling TMJ luxation and provides references to guide future clinical evaluation and decision-making.

To evaluate the efficacy of open reduction and internal fixation (ORIF) with disc reduction for pediatric condylar fractures (CFs) and assess mandibular growth outcomes using three-dimensional (3D) CT measurement. Patients under 18 years with CF who underwent ORIF with disc reduction were recruited in the study. CT data including pre-operation, post-operation and at least 1 year follow-up were measured by ProPlan CMF 3.0 software for mandibular ramus height, mandibular body length, chin deviation and retrusion. Complications including bone resorption, fixation failure, temporomandibular joint ankylosis (TMJA), etc. were recorded. 18 patients with 25 condylar fractures were included in the study. There were 6 males and 12 females with the mean age of 13.44 years (SD 2.87). 40% (n=10) of them were intracapsular condylar fractures, 52% (n=13) were condylar neck fractures and 8% (n=2) were subcondylar fractures. After ORIF, the mandibular ramus height was restored 4.53mm (SD 2.89). Chin deviation was corrected 3.87mm (SD 2.29) and chin retrusion was improved 3.29mm (SD 2.88). After an average follow-up of 26.39 months (SD 13.19), the ramus grew 2.48mm (SD 3.87) with no progressing jaw deformity. There were no complications such as hardware failure and ankylosis. ORIF with disc reduction is effective for the treatment of pediatric CFs with regard to restoration of mandibular ramus height and prevention of progressive jaw deformity, bone resorption and ankylosis.

eP140 TOP 20 One stage management of a complex case of inflammatory arthropathy presenting with TMJ ankylosis, an atypical facial asymmetry & skeletal class 3 dentofacial disproportion

245 - Breaking the Chains of TMJ Ankylosis: A Surgery-First Approach for Instant Facial Transformation and Functional Freedom

373 - Orthognathic Management of Bilateral TMJ Ankylosis with Mandibular Hypoplasia: A Case Report

From Rigidity of a Closed Jaw to the Freedom of Movements: Lateral Arthroplasty with ADFG as a Minimally Invasive Alternative for He and Yang Type A2 and A3 TMJ Ankylosis

Abstract Introduction: Recurrent bilateral temporomandibular joint (TMJ) ankylosis poses a significant challenge due to limited treatment options and extensive functional impairment. Alloplastic total joint replacement (TJR) represents a potential solution, particularly custom-made devices that allow for precise anatomical reconstruction. However, data on the efficacy of custom-made TJR in this specific population remains limited. This study aimed to evaluate the functional outcomes of custom-made alloplastic TJR in managing recurrent bilateral TMJ ankylosis. Specific outcomes assessed include maximal incisal opening (MIO), postsurgical malocclusion, heterotopic bone formation and dietary restriction patient satisfaction. Materials and Methods: This study was a retrospective study on six patients who underwent custom-made alloplastic TJR for recurrent bilateral TMJ ankylosis at a single institution. Preoperative and postoperative MIO and dietary restrictions were evaluated. Radiographic assessments, complications, patient satisfaction and quality of life after surgery were documented. Results: Custom-made TJR resulted in a significant increase in mean MIO from 5.5 mm (standard deviation [SD]: 5.54 mm) preoperatively to 35.17 mm (SD: 2.99 mm) at 1-year follow-up. All patients demonstrated improvement in dietary restrictions. The radiographic assessment showed stable prostheses. No major complications were observed, and all patients reported satisfaction with the surgical outcome. Discussion: This study suggests that custom-made alloplastic TJR is a viable treatment option for patients with recurrent bilateral TMJ ankylosis, leading to substantial improvements in mouth opening, pain reduction and overall function. Larger, prospective, multi-centre studies are needed to confirm these findings and further evaluate the long-term outcomes.

Introduction Temporomandibular Joint (TMJ) ankylosis is a debilitating condition that can lead to severe functional limitation and dentofacial deformities. We report a case of a young adult male with unilateral left bony TMJ ankylosis, presenting with a Class II Division 1 malocclusion on a Class II skeletal base, marked mandibular retrognathia (micrognathia) with chin deficiency, and facial asymmetry. Case Presentation A 16-year-old male presented with a 10-year history of restricted mouth opening following trauma (fall from a bicycle). Clinical and radiographic evaluation revealed left-sided bony TMJ ankylosis with associated facial asymmetry, chin deviation, and micrognathia. Mouth opening was limited to 4 mm. The patient underwent interpositional gap arthroplasty with temporalis muscle graft and advancement genioplasty in a single operative session. Postoperatively, there was gradual and sustained improvement, with mouth opening reaching 40 mm at 1-year follow-up. The surgical site remained healthy, and significant aesthetic enhancement was achieved. Conclusion This case demonstrates that single-stage surgical correction of TMJ ankylosis and associated facial deformities, such as micrognathia, is not only feasible but also effective in improving both function and facial harmony. Early surgical intervention using a combined approach can prevent long-term complications such as obstructive sleep apnea, speech disturbances, and psychological distress, making it a valuable strategy in managing pediatric and adolescent TMJ ankylosis.

This report aims to present a case of temporomandibular joint (TMJ) ankylosis in a patient with Neurofibromatosis type 1 (NF1). It is a rare but significant long-term complication of NF1-associated craniofacial dysplasia, potentially aggravated by prior orthognathic surgery. The patient, a 58-year-old woman with NF1 developed complete left TMJ ankylosis 14 years after bimaxillary surgery. The patient had a neurofibroma involving the mandibular branch (V3) of the trigeminal nerve, with fatty atrophy of the ipsilateral masticatory muscles. Clinical examination revealed marked facial asymmetry, severe trismus with a maximal mouth opening of 10mm and tilting of the occlusal plane. Imaging studies confirmed ankylosis and extensive craniofacial bone dysplasia. Management was conducted in two surgical stages. The first involved resection of the ankylotic mass and placement of a temporary spacer. The second included orthognathic surgery and insertion of a custom-made TMJ prosthesis. Postoperative assessment showed improved mouth opening to 32mm, with satisfactory aesthetic and functional outcomes. NF1 is a genetic disorder characterized by a wide spectrum of systemic manifestations, including craniofacial skeletal anomalies. Although mandibular deformities are commonly observed in patients with facial plexiform neurofibromas, TMJ ankylosis is a rare and poorly documented complication. It underscores the need for individualized surgical planning and long-term surveillance in NF1 patients with facial neurofibromas and skeletal deformities. Clinicians should maintain a high index of suspicion for progressive joint pathology in NF1 patients. Early recognition and proactive management are essential to prevent irreversible joint damage. To our knowledge, this represents the first documented case of true TMJ ankylosis associated with NF1, confirmed both radiologically and surgically. Not applicable.

Objective: A C57/BL6 mouse model of traumatic temporomandibular joint ankylosis (TTMJA) was established through composite trauma to lay the foundation for studying the pathophysiology of TTMJA. Methods: This study was conducted from January 2024 to February 2025. Forty-two 4-weeks old C57/BL6 mice, numbered 1 to 42, are randomly assigned to a control group (n=21) and an experimental group (n=21) using a computer-generated random number sequence. The experimental group undergoes modeling surgery on the left temporomandibular joint (TMJ), while the control group is routinely raised without special treatment. At 12 weeks post-surgery, the TMJ complex of both groups is assessed via body weight and mouth opening measurements, gross observation, micro-CT, and histological staining to evaluate model establishment. Results: At 12 weeks post-operation, in the experimental group, the body weight of mice [(27.75±1.08) g] did not show a significant difference compared with that of the control group [(30.80±0.29) g](t=0.54,P=0.610). The maximum vertical passive mouth opening [(1.70±0.26) mm] in the experimental group was significantly lower than that in the control group [(3.43±0.21) mm](t=8.92,P<0.001). Gross observation indicated that the right TMJ structure of the experimental-group mice was normal, while irregular hyperplasia occurred in the left TMJ complex. Micro-CT revealed that at 12 weeks post-operation, the right joint structure of the experimental-group mice was normal, with regular condyles and glenoid fossae. On the left side, a large amount of bone hyperplasia occurred on the lateral side of the joint in the condyles and glenoid fossae, forming two irregular bone masses, and there was an uncalcified radiolucent zone between the bone masses. In histological staining, no new cartilage or bone tissue was observed in the left joint space of the control-group mice, and the articular disc structure was normal. In the experimental-group mice, obvious new cartilage and calcified bone tissue were visible on the lateral side of the left joint space. A bone bridge was formed between the condyles and glenoid fossae, the articular disc structure disappeared, and bony ankylosis occurred. Conclusions: In this experiment, a TTMJA model of C57/BL6 mice was initially established by removing the articular disc and damaging part of the fibrous cartilage of the glenoid fossae and condyles, providing an experimental platform for further research on the pathogenesis of TTMJA.

Temporomandibular joint ankylosis (TMJA) causes immobility due to fusion of the joint. It most often results from trauma or infection, but it may be congenital or a result of rheumatoid arthritis. The condition is very common in children and rarely seen in adults. Administration of effective and safe anesthesia to patients with TMJA often poses a serious challenge during surgical correction. Hence, we report a case of a 68-year-old Nigerian woman with no comorbidities who presented to the Oral and Maxillofacial Surgery clinic of our facility with a 5-year history of progressive limitation of mouth opening associated with a painful left cheek swelling. Examination revealed severely limited mouth opening with an interincisal distance of 6 mm. Computerized tomogram of the jaws and the TMJ showed fusion of the condylar head and the temporal articular fossa on the left TMJ. She underwent gap arthroplasty after successful awake nasotracheal intubation via fibreoptic bronchoscope and recovered uneventfully with no recurrence.

Does Lateral Pterygoid Muscle Reattach After Ramus-Condyle Unit Reconstruction in Temporomandibular Joint Ankylosis Patients?

Can Evoked Electromyography Detect Postoperative Facial Nerve Recovery Earlier Than Grading Scales Following Temporomandibular Joint Ankylosis Surgery?

Role Of Rhoa/Rock Pathway In Early Tmj Ankylosis Development

Objective: This retrospective study quantitatively evaluated linear and volumetric dimensions of the joint space created following gap arthroplasty (GA) and interpositional arthroplasty (IA) in temporomandibular joint ankylosis (TMJA) management, analyzing 10 patients (7 female, 3 male). Methods: Demographic, etiological, and surgical data were extracted from institutional archives. Pre- and postoperative cone beam computed tomography (CBCT) scans enabled joint space assessment, with linear measurements at anterior (AJS), superior (SJS), and posterior (PJS) joint spaces in coronal views. Three-dimensional volumetric analysis was performed using Mimics Innovation Suite Software. Results: GA demonstrated a mean interosseous distance of 5.92 mm (range: 3.56-9.78 mm) with corresponding space volumes ranging from 560.46 mm³ to 2194.66 mm³. IA showed mean interosseous distances at 6.85 mm (range: 2.8-11.83 mm), with volumetric measurements between 910.73 mm³ and 2738.08 mm³. All patients achieved clinically significant improvements in maximum interincisal opening, with a mean increase of 28.09 mm. Notably, no cases of reankylosis were observed throughout the mean follow-up period of 16.2 months. Conclusions: Both GA and IA effectively restored TMJ function, with early physiotherapy initiation being a critical success factor. While cost-effective, procedure selection should be individualized based on age, ankylosis type, and anatomical considerations. Although limited by sample size and follow-up duration, these findings validate both techniques, warranting further large-scale studies to establish definitive guidelines.

SummaryA 3‐year‐old Arabian mare was referred for evaluation of swelling beneath the tongue, unilateral facial swelling, mandibular abscess drainage, severe oral cavity wounds, anorexia and depression. Radiographic imaging revealed a metallic foreign body located near the caudal molars, adjacent to the laryngeal region. Due to significant trauma‐induced temporomandibular joint (TMJ) ankylosis and severe limitation in mouth opening, surgical access was extremely challenging. After extensive planning, the mare was anaesthetised and after 90 min of delicate manipulation, the foreign object, identified as a needle embedded within the daily forage, was successfully retrieved. Postoperative wound management and medical therapy led to complete recovery over 2 weeks. This case emphasises the importance of considering intraoral foreign bodies in horses presenting with unexplained facial swelling and oral trauma.

Management of Post-traumatic Unilateral Temporomandibular Joint Ankylosis Caused by Undiagnosed Pediatric Condylar Fracture: A Case Series

Management of Post-traumatic Sawhney\'s Type II Temporomandibular Joint Ankylosis with Functional Physiotherapy Appliance: A Case Report