Piezo-Assisted Gap Arthroplasty: A Safer Surgical Approach for Temporomandibular Joint Ankylosis

Temporomandibular joint ankylosis (TMJa) is an incapacitating disease due to the fusion of the mandibular condyle with the temporal bone, leading to restricted mouth opening. In children, early surgical intervention is required to avoid alterations in growth and irreversible facial deformity. This case report outlines the treatment of unilateral Type III bony TMJa with piezo-assisted gap arthroplasty and pedicled buccal fat pad interposition in a six-year-old female. We performed osteotomy with a piezoelectric surgical device to control bone resection and decrease the potential for injury to surrounding soft tissues and vital structures. Incision was made approximately 10 mm apart, and ipsilateral coronoidectomy of the mandible was performed to increase range of motion. Early physiotherapy was performed postoperatively to maintain functional mouth opening. The patient showed more than 20 mm mouth opening when followed up, with good functional recovery. The piezoelectric surgical technique offers an accurate, secure modern approach for the surgical management of TMJa compared to the conventional rotary instruments.