Condyle-preserving lateral arthroplasty for fibro-osseous temporomandibular joint ankylosis using customized cutting guides: a case report

Abstract Background Temporomandibular joint ankylosis causes progressive restriction of mandibular movement and is primarily managed surgically, although the need for routine condylar resection remains controversial. Virtual surgical planning and patient-specific cutting guides may facilitate condyle-preserving resection, but their application for this purpose remains insufficiently explored. Case presentation We report the case of a 17-year-old male patient with a history of untreated right condylar fracture during childhood, which progressed to Sawhney type II fibro-osseous ankylosis of the ipsilateral TMJ. Clinically, the patient presented with severe limitation of mouth opening (14 mm), impaired masticatory function, and facial asymmetry. The diagnosis was confirmed by computed tomography with three-dimensional reconstruction. Surgical treatment consisted of a condyle-preserving lateral arthroplasty, releasing the osseous bridge through customized-guide-assisted ostectomy with preservation of the mandibular condyle and of the articular disc, complemented by guided bilateral coronoidectomy. Intraoperative maximal interincisal opening was 25 mm after release of the ankylotic block and 32 mm after bilateral coronoidectomy. At follow-up visits at 15 days, 1 month, 4 months and 12 months, mouth opening progressed from 23 mm to 30 mm, 35 mm and 38 mm respectively, with recovery of masticatory function and improved facial symmetry, and no clinical evidence of recurrence during the follow-up period. Conclusions In selected young patients with TMJ ankylosis and a morphologically viable condyle, lateral arthroplasty with condylar preservation, complemented by bilateral coronoidectomy and early postoperative physiotherapy, may represent a lower-morbidity alternative to more radical approaches. The use of customized cutting guides contributed to precise resection of the ankylotic mass, allowing adequate delineation of the skull base and greater surgical safety during condylar preservation.