Unilateral temporomandibular joint ankylosis with contralateral aplasia
A 6-year-old female patient reported to our outpatient department with the complaints of nil mouth opening, facial disfigurement, and night episodes of respiratory distress. On examination, the patient had no movements of the right TMJ, with pronounced antigonial notches on either side or reduced chin []. Systemically, the patient had all the signs and symptoms of obstructive sleep apnea syndrome (OSAS) with PC of the chest [Figures and ]. The patient's chief complaint was respiratory distress with facial asymmetry, which was first noticed in childhood and gradually progressed. Panoramic examination revealed that the right mandibular condyle exhibited ankylotic changes, while there was complete absence of the left condylar head and the ramus terminated relatively obliquely below the level of the sigmoid notch []. For obtaining further information, the patient was submitted to a DentaScan evaluation. The images revealed the complete absence of the left condylar head and neck []. On evaluating the patient for excluding the syndromes, the chest exhibited PC (pigeon breast) with shallow breathing and chest expansions. PA chest revealed a barrel-shaped chest with normal lung and heart fields. The patient was further evaluated for episodes of apnea and snoring.\nPreparations were made for emergency access to the airway. IV line was established and the patient was sedated for blind intubation. After successful blind nasotracheal intubation from the left nostril, access to bony chunk on the right TMJ region was made with the help of AlKayat–Bramley incision and the bony chunk was relieved. Intraoperative mouth opening of 3.5 cm was achieved and the gap was interpositioned with temporal fascia. Layer wise closure was done. Post-surgical active jaw physiotherapy was started after 48 h of surgery. Mouth opening was maintained at 3.2 cm after 15 days of follow-up.