Unlocking the airway through mandibular distraction followed by TMJ release in bilateral TMJ ankylosis complicated by severe OSA.
Adil Gandevivala, Srivalli Natarajan, Nitesh Dinesh Patkar et al.
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Case in brief
An early adolescent with bilateral TMJ ankylosis presented with severe obstructive sleep apnoea (OSA), facial asymmetry, and a limited mouth opening of 2 mm. A staged surgical approach was implemented, starting with a tracheostomy to secure the airway, followed by mandibular distraction osteogenesis, which significantly improved OSA symptoms and airway dimensions. After TMJ release and gap arthroplasty, the patient achieved an interincisal opening of 35 mm, and a follow-up PSG showed an AHI of 0.6.
Diagnostic / clinical pearl
In cases of TMJ ankylosis with severe OSA, a staged surgical approach with careful airway management is crucial due to the high risk of difficult intubation.