Discussion

TMJa in children requires early surgical intervention to prevent progressive skeletal deformity and functional impairment [1,3]. The present case involved a six-year-old child diagnosed with unilateral Type III bony ankylosis according to Sawhney’s classification. Type III ankylosis is characterized by a bony bridge between the temporal bone and the mandibular ramus with a medially displaced condyle, often requiring aggressive surgical resection for adequate joint release.

Gap arthroplasty remains an established treatment modality; however, recurrence remains a concern [4]. Adequate bone removal and strict postoperative physiotherapy are critical determinants of long-term success. In the present case, a 10-mm gap was created to reduce the likelihood of re-ankylosis.

There are advantages to piezoelectric surgery over rotary osteotomy techniques. Because a selective cutting mechanism leaves adjacent soft tissues uninjured, there is less risk of damaging vital structures such as the facial nerve, internal maxillary artery, and middle cranial fossa [5]. Piezoelectric surgery for TMJa release reduces bleeding and complications, while allowing precise bone cutting. It appears to be a safe and effective alternative to the conventional technique [7].

Piezoelectric surgery is now used for many surgical procedures in oral and maxillofacial surgery, such as dental implants, implant-site preparation, alveolar ridge splitting, bone graft harvesting, lateralization of the inferior alveolar nerve, orthognathic surgery, aesthetic facial surgery, distraction osteogenesis, inferior alveolar nerve preservation, and trauma [8].

Autogenous interpositional materials remain preferable in pediatric patients due to their biological compatibility and adaptability during growth. Vascularized tissues such as the buccal fat pad provide a reliable and well-vascularized interpositional barrier that helps reduce the risk of recurrence [9,10]. It is well established that postoperative physiotherapy plays a key role in preventing re-ankylosis and functional rehabilitation.