Early surgical correction of unilateral TMJ ankylosis and improvement in mandibular symmetry with use of an orthodontic functional appliance--a case report.

Early ankylosis of the temporomandibular joint (TMJ) can be a deterrent to normal mandibular growth. The frequency of occurrence is rare in the population of young patients who undergo orthodontic treatment. Early diagnosis of TMJ ankylosis is important and early surgical intervention is now an accepted mode of treatment. Ankylosis infers minimal, if any joint function. Caldwell argues that restoration of joint function at an early age is necessary to activate as much growth potential as possible. Laboratory and clinical studies have supported the theory that the mandibular condyle is adaptable under function and perhaps even the most deformed condylar head may exhibit growth when released and placed in function. The purpose of this article is to present a case report of surgical release of TMJ ankylosis followed by radiographic and clinical evidence of unilateral condylar growth. The surgical procedure involved maintenance of the condyle, the disk and majority of fibrocartilage covering the mandibular condyle. Aggressive postoperative physical therapy and the employment of a functional orthodontic appliance appeared to have assisted in a more symmetric growth pattern and maintenance of appropriate function.