Simultaneous total correction of temporomandibular ankylosis and facial asymmetry.

Ankylosis of the temporomandibular joint not only prevents mouth opening and chewing, but also affects the growth and position of the mandible. This produces progressive facial distortion with devastating psychosocial effects compounding the already difficult problem of not being able to open the mouth. Over the past 6 years, 18 patients in Canada and Taiwan were treated by excision of a large block of bone at the ankylosis and repositioning of the jaw, with the addition of osteotomies as necessary to produce a symmetrical face with good occlusion. Bilateral cases were treated at one operation in a similar way. The temporomandibular joint and absent ramus were constructed with a costochondral graft taken from the opposite chest. Some patients were treated with intermaxillary fixation for 8 weeks, while others had no fixation, but there was no difference in the effectiveness of correction of the ankylosis.