Temporomandibular Joint Ankylosis Relapse in Childhood: Functional and Skeletal Correction Using a Customized Total TMJ Prosthesis and Orthognathic Surgery—A 2-Year Follow-Up Case Report.

Temporomandibular joint ankylosis (TMJA) is debilitating condition characterized by fibrous or bony fusion of the disc-condyle complex to the temporal articular surface. In growing patients, this condition disrupts mandibular development and leads to severe dentofacial deformities and functional impairment. This case report describes the management of a 14-year-old female with recurrent TMJA and severe mandibular asymmetry after costochondral grafting performed at age six. Virtual surgical planning, bimaxillary orthognathic surgery, and unilateral customized total TMJ replacement were used in a single-stage protocol. At the 2-year follow-up, the patient demonstrated a stable increase in maximum mouth opening, improved occlusion, and enhanced facial symmetry without relapse. This case highlights the feasibility of alloplastic TMJ prostheses as a reconstructive option in select pediatric patient with recurrent ankylosis. Management of childhood TMJA is complex and requires extensive and rigorous planning; a customized TMJ prosthesis may represent a viable and safe option to improve clinical parameters in young patients. • Recurrent pediatric TMJ ankylosis after costochondral grafting resulted in severe mandibular asymmetry and functional limitation. • Management used a single-stage protocol combining, bimaxillary orthognathic surgery, and customized total TMJ prosthesis. • Two-year follow-up showed stable mouth opening, normalized occlusion, improved facial symmetry, and no evidence of relapse or prosthetic complications. • Comprehensive surgical planning is crucial to simulate movements, optimize osteotomies and prosthesis design; ensure precise intraoperative execution in this complex deformity.