Abstract
We describe the clinical course of a pediatric patient with unilateral temporomandibular joint (TMJ) ankylosis who underwent successful open TMJ surgery with gap plasty and follow-up to adulthood. The patient was a 12-year-old girl with ankylosis of the right TMJ (Sawhney Classification Type III) secondary to a condylar fracture. At the initial visit, her mandible was slightly deviated to the affected side, and mouth opening range (MOR: interincisal distance) was 11 mm. At the age of 14 years, she firmly decided to carry out postoperative mandibular motion exercises with pain, and open TMJ surgery was performed. The first step of the surgical procedure was gap plasty for the bony ankylosis of the outer side of the right TMJ while preserving the normal TMJ structure in its inner site, and a temporal muscle/fascia flap was inserted into the gap. Then, the healthy-side temporal muscle was detached from the coronoid process, resulting in the achievement of 50-mm MOR. From the day after surgery, mandibular-motion exercises were started, and the MOR reached 40 mm within 10 days postoperatively. Thereafter, she continued mandibular-motion exercises, and we recognized no facial asymmetry or mandibular-motion disorders with 40-mm MOR at the 6-year follow-up after surgery. In conclusion, the mandibular mobility that was achieved, together with preservation of the normal TMJ structure, through our surgery and postoperative continuous mandibular-motion exercises were crucial factors that prevented growth disturbance of the mandible in our patient.
