Management of temporomandibular ankylosis--compromise or individualization--a literature review

Navigating Complexity in Mandibular Condyle Aplasia and Temporomandibular Joint Ankylosis in a Five-Year-Old Child: A Case Report

Mandibular condyle aplasia and temporomandibular joint (TMJ) ankylosis represent complex challenges in diagnosis and management, affecting jaw function and facial aesthetics. This case report presents a five-year-old female child with a right-sided small jaw and facial asymmetry due to left-sided TMJ ankylosis. The coexistence of mandibular condyle aplasia and TMJ ankylosis underscores the need for comprehensive evaluation and tailored treatment approaches. Syndromic associations, such as Goldenhar syndrome and Treacher Collins syndrome, further complicate diagnosis and management. Surgical intervention involving left-side gap arthroplasty and reconstruction using a costochondral graft/temporalis fascia was performed under general anesthesia. However, postoperative complications, including decreased mouth opening and left-sided lower motor neuron facial palsy, necessitated further surgical debridement and drainage of an abscess. The case emphasizes the importance of a multidisciplinary approach in addressing complex craniofacial anomalies, with treatment strategies such as bone grafting and tailored surgical interventions offering promising outcomes. Understanding the multifaceted etiology of mandibular condyle aplasia and TMJ ankylosis is crucial for optimal management, highlighting the collaborative efforts required for achieving favorable patient outcomes.

Facial Deformity in an Operated Case of Bilateral Temporomandibular Joint Ankylosis

Temporomandibular joint (TMJ) ankylosis results in malocclusion, poor feeding, difficulty in maintaining oral hygiene, and facial esthetic deformity. The basic surgical objectives in the treatment of TMJ ankylosis are to establish joint movement, prevent relapse, and achieve normal growth and development. Here, we present an operated case ofsurgical correction of mandibular hypoplasia; however, the patient came back after three years due to unsatisfactory results and underwent bilateral coronoidectomy and gap arthroplasty. Bones were osteotomized at the LeFort I level and the maxillary segment was down-fractured and mobilized to bring into occlusion with the mandible. In the present case, the lower pharyngeal airway changed from 5 mm pre-treatment to 10 mm post-treatment, and the facial angle was changed from 73 to 84 post-treatment. Assessment of the pharyngeal airway is done with a high suspicion of obstructive sleep apnea and facial deformity is mandatory in the management of TMJ ankylosis.

Complications of Mandibular Fracture Repair

Mandible fracture management has evolved dramatically. Therefore, the variety of surgical complications associated with mandibular fractures, and their incidences, have continued to change as well. This article aims to assess the most common and most concerning complications that can occur secondary to management of mandibular fractures by examining categories of complication types. This article also explores factors and techniques associated with reduced rates of complications as well as the management of complications.

Orthomorphic Correction for Facial Asymmetry in a Patient With Long-Standing Temporomandibular Joint Ankylosis: A Case Report

This case report presents the successful management of a 28-year-old female patient with facial deformity resulting from long-standing temporomandibular joint (TMJ) ankylosis. The patient underwent orthomorphic correction using a stereolithographic model of the upper and lower jaw to aid in surgical planning. The surgery was performed under general anesthesia via an intraoral approach. Cancellous bone graft harvested from the anterior iliac crest was utilized to cover the bone defect caused by the orthomorphic rotation of the lower jaw. The patient experienced satisfactory postoperative healing, and a six-month follow-up revealed significant improvement in facial symmetry and function.

Total temporomandibular joint replacement in recurrent temporomandibular joint ankylosis: a case report

Total temporomandibular joint replacement (TMJR) is a surgical procedure in which end-stage temporomandibular joint disorders are replaced with an alloplastic prosthesis between the mandible and the base of the skull when autogenous grafts are inadvisable. These alloplastic prostheses may be available as stock or custom-made prostheses consisting of the mandibular condyle and glenoid fossa components. Although the first total temporomandibular joint prosthesis was used in the 1960s, we present the case of a 20-year-old female patient, probably the first case of total temporomandibular joint arthroplasty in Nepal, performed at Dhulikhel Hospital in Kavrepalanchok. The patient underwent bilateral TMJR with a custom joint prosthesis for recurrent TMJ ankylosis. Postoperatively, the patient noticed significant improvements in mouth opening, chewing ability, facial esthetics and, most importantly, her self-esteem and confidence.

Temporomandibular Joint Ankylosis among Patients at Saint Paul's Hospital Millennium Medical College, Ethiopia: A 9-Year Retrospective Study

Background

Temporomandibular joint ankylosis (TMJA) is a gradually developing pathological condition manifested by a limited mouth opening. It can result in an extremely disabling deformity that may affect mastication, swallowing, speech, oral hygiene, and facial cosmetic appearance. The present study aimed to determine the pattern of TMJA at St. Paul's Hospital millennium medical college (SPHMMC), Addis Ababa, Ethiopia.

Methods

A retrospective descriptive study design was conducted at SPHMMC. All medical records of patients with the diagnosis of TMJA that visited the Maxillofacial Surgery unit from September 2010 through August 2019 were reviewed. Sociodemographic and clinical data including age, sex, place of residency, duration of TMJA cases, etiology, clinical presentations, imaging results, type of surgical operation, and complications after surgery were collected and analyzed using IBM SPSS software version 20 for Windows (Armonk, NY, USA: IBM Corp) computer program.

Results

A total of 130 patients' medical records were reviewed. Out of this, 95 were included in the study. Forty-two (44.2%) of the TMJA cases were males, while the remaining 53 (55.8%) were females with a male to female ratio of 0.79 : 1. 20-29-year-old patients were the most affected, 36 (37.9%), followed by the 30 to 39 years age group, 33 (34.7%). Trauma (77.9%) was identified as the most common cause of TMJA. Notably, bilateral ankylosis (72.6%) was more common than unilateral (27.3%), and micrognathia was the most common (23.0%) deformity observed. The majority 52 (54.7%) of TMJA patients were treated with gap arthroplasty.

Conclusions

TMJA was predominant among females than their male counterparts. Of note, 20-29-year-old patients were the most affected group. The majority of TMJA cases were treated by gap arthroplasty with almost no postoperative complications. Early detection and intervention to release the ankylosed joint is needed to improve patients' quality of life.

Ankylosis of the temporomandibular joint-impression free CAD/CAM based joint replacement using patient-specific implants

In recent years, alloplastic temporomandibular joint (TMJ) replacement has become a permissible procedure for the reconstruction of severely destroyed TMJs. The use of computer-aided design/computer-aided manufacturing (CAD/CAM) has extended the range of applications to complex anatomical situations. The aim of the treatment is to improve the usually restricted mouth opening and thus oral hygiene and nutrition, which leads to a regular improvement in the general quality of life. The following case report describes the bilateral replacement of ankylotically destroyed TMJs using patient-specific endoprostheses with simultaneous displacement of the maxilla. Innovative in the case described is the impression-free CAD/CAM planning, whereby the upper and lower prostheses were produced on the basis of 3D printed patient models.

Temporomandibular joint alloplastic reconstruction of post-traumatic joint degeneration with Sawhney Type I ankylosis using 3D-custom GD-condylar cap prosthesis to restore condylar form and function

Temporomandibular Joint (TMJ) ankylosis as a sequelae following hemarthrosis from trauma, middle ear infection and progressive debilitating arthritis of various etiologies has been well understood, but challenges always arise in terms of choosing least morbid procedure with maximum functional outcome. Total joint replacement (TJR) is the common final stage correction mandating extensive surgical exposure with good technical expertise with its limitations of risk of failure and complications. A case of post-traumatic TMJ degeneration with ankylosis reconstructed using a customised GD-condylar cap prosthesis is described. The patient had an uneventful post-operative period with an acceptable functional outcome. CONCLUSION: The condylar cap prosthesis is a bio-compatible and biomechanically designed in such a way that it can be used for indicated cases by performing minimally invasive surgical technique to achieve an optimal functional and aesthetic outcome.

Course of the Maxillary Vein and its Positional Relationship With the Mandibular Ramus Require Attention During Mandibuloplasty

PURPOSE

The maxillary vein is associated with major hemorrhage, an intraoperative risk factor during mandibuloplasty. Our objectives in this study were to identify the anatomical course of the maxillary vein relative to the mandible, and to ascertain the relationship of its course with that of the maxillary artery.

METHODS

Thirteen sides of 13 cadavers in the possession of the Department of Anatomy of Tokyo Dental College were used. The maxillofacial region was first dissected, after which the upper part of the mandibular ramus was removed and the maxillary artery, maxillary vein, and pterygoid venous plexus were identified. The length of the maxillary vein and its height from the mandibular plane were then measured, and its anatomical course was recorded.

RESULTS

The maxillary vein ran downward along the inner aspect of the temporal muscle, then from the base of the coronoid process it ran horizontally near the bone surface of the inner aspect of the mandibular ramus. After joining the inferior alveolar vein, it joined the superficial temporal vein to form the retromandibular vein. The mean length of the maxillary vein was 22.2 ± 3.2 mm. At the posterior margin of the mandibular ramus, its mean height above the mandibular plane was 34.2 ± 5.4 mm. From the posterior margin of the mandibular ramus to the lowest point of the mandibular notch, the maxillary vein was located within the areolar connective tissue directly above the periosteum adjoining the inner aspect of the mandibular ramus.

CONCLUSIONS

In the wide area from the center of the maxillary notch to the posterior margin of the mandibular ramus, the maxillary vein runs extremely close to the periosteum on the inner aspect of the mandibular ramus, suggesting that it may pose a risk of hemorrhage in various oral surgical procedures.

Evaluation of Success of Transport Disc Distraction Osteogenesis and Costochondral Graft for Ramus Condyle Unit Reconstruction in Pediatric Temporomandibular Joint Ankylosis

PURPOSE

The costochondral graft (CCG) is considered the reference standard for pediatric temporomandibular joint reconstruction. It has the disadvantages of unpredictable growth, donor site morbidity, and the need for intermaxillary fixation. It has been reported that transport disk distraction osteogenesis (TDDO) can result in the formation of a neocondyle and disc. We performed a randomized trial to measure and compare clinically relevant outcomes of ramus-condyle unit (RCU) reconstruction using CCG and TDDO for pediatric temporomandibular joint ankylosis (TMJA).

MATERIALS AND METHODS

In the present randomized controlled trial (block randomization with a variable block size), pediatric patients with unilateral, nonrecurrent TMJA aged 3 to 16 years who had presented to our unit from December 2015 to June 2017 were enrolled. Instead of temporalis myofascial flap interposition, a buccal fat pad was used to fill the gap created by osteoarthrectomy. The primary outcome parameter was mouth opening. A mouth opening of at least 25 mm at the median follow-up point was considered success. The secondary outcome parameters were occlusion, laterotrusion, protrusion, reankylosis, neocondyle, chin deviation, facial asymmetry, midline shift, and neo-disc formation. Data were analyzed using the independent t test and rank sum test.

RESULTS

A total of 24 patients were enrolled in the CCG and TDDO groups (n = 12 in each group). Trauma (40.9%) was the most common etiology with a slight male preponderance (59.09%). The mean age was 10.32 ± 2.85 years. The average distraction achieved in the TDDO group was 10.42 mm. The median follow-up duration was 31.5 months (range, 24 to 39 months). The mean preoperative maximal incisal opening had improved from 8.5 ± 4.1 and 9.5 ± 7.1 mm in the CCG and TDDO groups preoperatively to 35.7 ± 2.7 and 34.4 ± 8.9 mm, respectively, at the median follow-up point (P < .005). RCU reconstruction with both modalities resulted in improvement in all the parameters; however, the intergroup comparison showed statistically non-significant differences. No reankylosis or open bite was found. The 3-hour delayed gadolinium-enhanced magnetic resonance imaging scan showed successful neo-disc formation.

CONCLUSIONS

Similar success can be achieved in RCU reconstruction using either CCG or TDDO for pediatric TMJA. Both techniques have some advantages and disadvantages. RCU reconstruction using CCG or TDDO results in formation of a neocondyle, maintenance of occlusion, and correction of facial asymmetry.

Post-traumatic ankylosis of the temporomandibular joint in the dog – a case report

Temporomandibular ankylosis, even though considered to be of a relatively rare emergence, can be encountered in day-to-day clinical practice. Most cases follow a typical, if not identical anamnesis pattern. The background of mechanical difficulties manifestation is associated with some trauma. The animals usually suffer a severe blow to the head, leading to a gradual development of the defect, which unfortunately most owners are not aware of, or claim not to be. This case report describes a typical incidence of post traumatic ankylosis of the temporomandibular joint (TMJ). The patient suffered a blow to the head at the age of 4 months, the clinical aftermath of which was a gradual difficulty in opening the mouth. A CT examination revealed the extent of damage in the region of the zygomatic arch, affecting also the corresponding TMJ. For this particular case, a surgical intervention was the only course of treatment, meaning the resection of arcus zygomaticus and the TMJ. The procedure was scheduled to be performed 14 days post the CT examination. Due to the fact that the changes were located only on the lateral surface of the TMJ, the plan was to resect and remove the affected area only, with the medial part of the TMJ left intact and in position. The joint capsule was then sutured. This approach proved to be very beneficial and effective in the outcome of the surgery and in aiding in the overall comfort of the patient.

Management of unpredictable outcomes of costochondral grafts

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TMJ ankylosis is a debilitating mandibular hypomobility disorder.

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CCGs are generally considered as the gold standard for autogenous reconstruction of mandibular condyle.

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Total alloplastic TMJ prosthesis is a viable option in the case of undesirable outcomes from CCGs.

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Management of TMJ ankylosis in children is dependent on aggressive physiotherapy, and long-term follow-up.

Introduction

Temporomandibular joint (TMJ) ankylosis is a debilitating mandibular hypomobility disorder that may be associated with serious functional and aesthetic deformities including limited mouth opening, impaired mastication and disturbances of facial and mandibular growth. The ultimate treatment goal of TMJ ankylosis is to restore altered joint mechanics, correct associated dentofacial deformities and prevent reankylosis.

Presentation of case

We present a case of a 16 year old patient who returned with excessive mandibular growth and TMJ reankylosis following treatment of TMJ ankylosis with CCGs when he was 8 years old.

Discussion

Various treatment modalities for TMJ ankylosis have been described. These include gap arthroplasty (GAP), interpositional gap arthroplasty (IPG) and/or total joint reconstruction (with autogenous costochondral grafts or alloplastic materials), and distraction osteogenesis. Costochondral grafts (CCGs) are generally preferred for the treatment of TMJ ankylosis, especially in the growing patient. Their advantages include biocompatibility, no financial cost to the patient, low donor site morbidity, and most importantly their potential for mandibular growth. The growth of the mandible is however unpredictable.

Conclusion

The optimal surgical management of this complex patient with combined orthognathic surgery and total alloplastic joint reconstruction is discussed.

Technique of Dual Distraction for Correction of Unilateral Temporomandibular Joint Ankylosis With Facial Asymmetry: A Case Series

PURPOSE

Temporomandibular joint (TMJ) ankylosis, not only results in joint hypomobility, but also causes considerable facial deformity. Its unilateral variant can cause facial asymmetry, leading to major psychosocial effects on the individual.

PATIENTS AND METHODS

We present the cases of 7 patients with unilateral TMJ ankylosis and facial asymmetry of various grades who have been treated using gap arthroplasty and simultaneous dual distraction. Considerable debate has surrounded the sequencing of TMJ release and distraction osteogenesis; however, the simultaneous approach has recently become popular. The use of a single distractor simultaneously with TMJ release has been widely reported. However, one disadvantage with this technique is that the proximal condylar segment remains unstable. Dual distraction is a newer technique which we have proposed as a single-stage approach for the correction of TMJ ankylosis and facial asymmetry and to address the problems resulting from the use of a single distractor.

RESULTS

After treatment, all the patients showed a mouth opening ranging from 35 to 50 mm and satisfactory facial symmetry.

CONCLUSIONS

Dual distraction is a promising technique in the correction of facial asymmetry. However, further studies with adequate statistical analysis and larger sample size are required.

Association between the clinical features of and types of temporomandibular joint ankylosis based on a modified classification system

This study aimed to describe the clinical features of different types of traumatic temporomandibular joint (TMJ) ankylosis. Seventy-one patients with 102 ankylosed joints were retrospectively reviewed and categorized into four groups according to the grades of severity: type I, non-bony ankylosis of the joint with almost-normal joint space; type II, lateral bony ankylosis marked by a normal joint space that coexists with a radiolucent line; type III, complete bony ankylosis of the joint characterized by only a radiolucent line; and type IV, extensive bony ankylosis without any radiolucent line. The period of ankylosis, maximal mouth opening (MMO), rate of complications, and histopathological changes were compared among groups. Intergroup comparison showed significant differences in the clinical features of MMO and the incidence of complications (p < 0.05). Younger trauma patients tended to develop more severe types of ankylosis than older patients. Additionally, long post-trauma periods were related to the development of severe ankylosis. MMO was highly negatively correlated with the severity of ankylosis. Significant differences were noted among the four types of ankylosis. Younger trauma patients with long post-trauma periods tended to develop more severe TMJ ankylosis, experience more complications, and face more challenges in treatment than older patients.

Ankylosis of the Temporomandibular Joint in Pediatric Patients

INTRODUCTION

While surgical interventions for temporomandibular joint (TMJ) ankylosis are well-documented, there is lack of consensus regarding the ideal approach in pediatric patients. Surgical interventions include gap arthroplasty, interpositional arthroplasty, or total joint reconstruction.

METHODS

A systematic review of PubMed (Jan 1, 1990-Jan 1, 2017) and Scopus (Jan 1, 1990-Jan 1, 2017) was performed and included studies in English with at least one patient under the age of 18 diagnosed with TMJ ankylosis who underwent surgical correction. Primary outcomes of interest included surgical modality, preoperative maximum interincisal opening (MIO) (MIOpreop), postoperative MIO (MIOpostop), ΔMIO (ΔMIO = MIOpostop - MIOpreop), and complications.

RESULTS

Twenty-four case series/reports with 176 patients and 227 joints were included. By independent sample t tests MIOpostop (mm) was greater for gap arthroplasty (30.18) compared to reconstruction (27.47) (t = 4.9, P = 0.043), interpositional arthroplasty (32.87) compared to reconstruction (t = 3.25, P = 0.002), but not for gap compared to interpositional (t = -1.9, P = 0.054). ΔMIO (mm) was greater for gap arthroplasty (28.67) compared to reconstruction (22.24) (t = 4.2, P = 0.001), interpositional arthroplasty (28.33) compared to reconstruction (t = 3.27, P = 0.002), but not for interpositional compared to gap (t = 0.29, P = 0.33). Weighted-average follow-up time was 28.37 months (N = 164). 4 of 176 (2.27%) patients reported development of re-ankylosis. There was no significant difference in occurrence of re-ankylosis between interventions.

CONCLUSIONS

Given the technical ease of gap arthroplasty and nonsignificant differences in ΔMIO, MIOpostop, or occurrence of re-ankylosis between gap and interpositional arthroplasty, gap arthroplasty should be considered for primary ankylosis repair in pediatric patients, with emphasis on postoperative physiotherapy to prevent recurrent-ankylosis.

Temporomandibular Joint Regenerative Medicine

The temporomandibular joint (TMJ) is an articulation formed between the temporal bone and the mandibular condyle which is commonly affected. These affections are often so painful during fundamental oral activities that patients have lower quality of life. Limitations of therapeutics for severe TMJ diseases have led to increased interest in regenerative strategies combining stem cells, implantable scaffolds and well-targeting bioactive molecules. To succeed in functional and structural regeneration of TMJ is very challenging. Innovative strategies and biomaterials are absolutely crucial because TMJ can be considered as one of the most difficult tissues to regenerate due to its limited healing capacity, its unique histological and structural properties and the necessity for long-term prevention of its ossified or fibrous adhesions. The ideal approach for TMJ regeneration is a unique scaffold functionalized with an osteochondral molecular gradient containing a single stem cell population able to undergo osteogenic and chondrogenic differentiation such as BMSCs, ADSCs or DPSCs. The key for this complex regeneration is the functionalization with active molecules such as IGF-1, TGF-β1 or bFGF. This regeneration can be optimized by nano/micro-assisted functionalization and by spatiotemporal drug delivery systems orchestrating the 3D formation of TMJ tissues.

A New Method of Treatment of Temporomandibular Joint Ankylosis with Osteodistraction Using the Sh-Device: A Case Report

This case report presents a 16-year-old boy with bilateral temporomandibular joint (TMJ) bony ankylosis due to trauma. The patient had undergone several unsuccessful therapeutic surgeries and was experiencing reduced mouth opening, difficulty in eating and speaking, poor oral hygiene, snoring, and depression. Bilateral gap arthroplasty and distraction osteogenesis (DO) were performed. After the surgery, we were able to move the osteodistractors forward and prevent the upward and backward movement of the proximal mandibular segment with the use of our custom-made Sh-device, which allowed bone growth and soft-tissue matching. The mandibular deficiency was treated, and the patient's sleep quality significantly improved after three months. The physical, orthodontic and speech therapies were continued. The facial asymmetry, difficulty in sleeping, eating and speaking, and low self-esteem were completely resolved. At the 8-year follow-up, the patient's condition was satisfactory. The Sh-device can be used as a contemporary treatment modality for TMJ ankylosis.

Effectiveness of different surgical modalities in the management of temporomandibular joint ankylosis: a meta-analysis

BACKGROUND

A meta-analysis was conducted to evaluate the effectiveness of three surgical modalities-gap arthroplasty (GA), interpositional gap arthroplasty (IPG) and joint reconstruction (AR)-in treating temporomandibular joint (TMJ) ankylosis.

METHODS

A systematic review was performed using the PUBMED, EMBASE and OVID search engines in February 2015 to identify cohort studies with no restrictions, with the aim of evaluating the three surgical modalities. The outcome was the change between the pre- and postoperative maximal incisal opening (MIO). Analyses of category, heterogeneity, sensitivity and publication bias were performed. A fixed-effects model was used to compute the pooled weighted mean difference in the MIO among the different groups.

RESULT

Seventeen studies with 740 participants were included in the final analysis. The IPG therapy showed a significantly greater MIO when compared to GA (WMD=1.16 mm; 95% CI, 0.15-2.16) and AR (WMD=0.99 mm; 95% CI, 0.05-1.92) therapies. The weighted mean difference between the AR and GA modalities was 2.94 mm (95% CI, 0.12-5.75). The pooled odds ratios (ORs) of the recurrence rate for IPG, GA and AR were 0.01 (95% CI, 0.00-0.03), 0.03 (95% CI, 0.00-0.07) and 0.06 (95% CI, 0.04-0.09), respectively.

CONCLUSION

The analysis showed that IPG was more effective and displayed a lower recurrence rate, followed by AR and GA, in treating TMJ ankylosis. Thus, this analysis provides strong evidence supporting IPG as a first-line therapy for TMJ ankylosis.

Severe bony ankylosis of the temporomandibular joint on one side and contralateral adhesion: A case report

Bony fusion between the mandibular condyle and skull base involves temporomandibular joint (TMJ) bony ankylosis. This condition might originate from trauma, infection, or systemic disease. TMJ adhesion can develop after synovial damage. Both TMJ ankylosis and adhesion lead to functional impairment and pain. Here, we present a case of a 50-year-old female who had bony ankylosis of the right TMJ and adhesion of the left TMJ. She had otitis media in the right ear. A large mass in the right TMJ was observed on computed tomograph. Magnetic resonance image showed a large fused bone mass with normal bone marrow in the right TMJ and flattening of the condyle with a thin disk in the left TMJ. Gap arthroplasty with temporal fascia was performed on the right TMJ, and discectomy, high condylectomy, and coronoidectomy were performed on the left TMJ. During a 2-year follow-up after surgery, the patient had no recurrence.

Surgical treatment of posttraumatic ankylosis of the TMJ with different pathogenic mechanisms

OBJECTIVE

Posttraumatic ankylosis of the TMJ can be caused by many different pathogenic mechanisms. Prosthetic alloplastic grafts and autogenous grafts are the options for surgical treatment.

METHODS

Seven patients were examined clinically and radiologically. Autogenous interpositioners were used for treatment of TMJ ankylosis.

RESULTS

No major complications were seen after surgery. Interincisal distances have significantly widened following mouth opening exercises for one year.

CONCLUSIONS

Human skulls have many structure and shape differences, so it is difficult to replace a jaw joint successfully with an artificial one. Using autogenous tissues seems an appropriate choice for treatment.

TMJ Ankylosis: Multidisciplinary Approach of Treatment for Dentofacial Enhancement-A Case Report

This report describes the multidisciplinary phasewise treatment of a 20-year-old female patient having unilateral right TMJ bony (true) ankylosis whose mouth opening was restricted to 2 mm and mandibular retrognathism; additionally, she was also suffering from speech problems, snoring, difficulty in breathing, and low level of self-esteem and self-confidence. Bilateral gap arthroplasty and temporalis myofascial graft interpositioning through preauricular approach were done in surgical phase followed by the aggressive jaw physiotherapy in postsurgical period. Oral prophylaxis and restorations were followed by the fixed orthodontic therapy to resolve bimaxillary protrusion. Advancement sliding genioplasty was performed to enhance the chin button. Speech therapy and psychological counseling were also performed from time to time to boost up the self-esteem and self-confidence. At the end of treatment, facial esthetics was improved considerably and patient got over the impact of disfigurement, impaired functions, and psychosocial stigma. Rationale to use the multidisciplinary team approach in treatment of such cases is discussed.