Introduction

Temporomandibular joint ankylosis (TMJa) is a disabling craniomaxillofacial condition resulting from fibrous or bony fusion of the mandibular condyle with the temporal bone, leading to reduced mandibular movement and impaired facial growth [1]. The condition predominantly affects children and adolescents. The underlying pathophysiology involves intra-articular hemorrhage or inflammation following trauma or infection, which promotes fibrosis and subsequent heterotopic bone formation across the joint space. Progressive ossification ultimately restricts condylar movement and alters normal mandibular growth, making early diagnosis and surgical intervention essential to restore function and prevent irreversible craniofacial deformity [2]. Untreated ankylosis in pediatric patients may result in mandibular hypoplasia, facial asymmetry, malocclusion, compromised airway function, and significant psychosocial distress [3].

Several surgical approaches have been described for the management of TMJa, including gap arthroplasty, interpositional arthroplasty, and joint reconstruction. Gap arthroplasty remains a widely used technique; however, recurrence rates reported range from 2.56% to 11.9% depending on surgical technique and postoperative physiotherapy compliance [4]. Piezoelectric surgery has emerged as an alternative to conventional rotary instruments. The technique selectively cuts mineralized tissues and prevents injury to adjacent soft tissues and important neurovascular structures [5].

This report describes the successful management of unilateral Sawhney’s Type III bony TMJa (bony bridge between the mandibular ramus and the zygomatic arch) in a pediatric patient using piezo-assisted gap arthroplasty with autogenous interpositional grafting.