Bilateral Temporomandibular Joint Ankylosis Treated With Combined Intraoral and Extraoral Gap Arthroplasty: A Case Report.

Temporomandibular joint (TMJ) ankylosis causes severe limitation of mouth opening and functional impairment. Surgical management requires careful selection of approach and interpositional material to prevent recurrence and preserve function. We report a case of post-traumatic bilateral TMJ ankylosis treated by gap arthroplasty using different surgical approaches on each side. Because the patient had a right ocular prosthesis, preservation of the left facial nerve and visual function was considered essential. Therefore, the right side was managed using an extraoral approach with a temporalis muscle flap, whereas the left side was treated intraorally using a buccal fat pad flap. Postoperative rehabilitation resulted in improved mouth opening and stable occlusion without clinical evidence of recurrence during the 3.5 years of follow-up. This case highlights the importance of individualized surgical planning based on anatomical and functional considerations in the management of bilateral TMJ ankylosis.