Total alloplastic temporomandibular joint replacement in an adolescent with bilateral ankylosis and revision to...

Temporomandibular joint (TMJ) ankylosis in growing patients may result in severe mandibular hypomobility, progressive dentofacial deformity and upper airway compromise. The selection of reconstructive treatment remains challenging because autologous reconstruction offers growth potential, whereas alloplastic replacement enables immediate mobilization and precise correction of complex deformities. We report the staged management of a 15-year-old female patient with bilateral destructive TMJ ankylosis, marked mandibular retrognathia and tracheostomy-dependent airway obstruction. Treatment consisted of Computer Aided Design/Computer Aided Manufacturing (CAD/CAM)-guided mandibular distraction followed by bilateral total alloplastic TMJ replacement (TMJ-TJR). Persistent aseptic soft-tissue swelling and confirmed chromium and nickel hypersensitivity required revision to all-titanium components 12 months later. After revision, the soft-tissue reaction resolved completely. At 12 months after completion of surgical treatment, mouth opening exceeded 3 cm, the patient was pain-free and facial aesthetics and subjective well-being had improved. This case illustrates the role of staged patient-specific alloplastic reconstruction in selected adolescent patients with advanced TMJ ankylosis.