Temporomandibular Joint ankylosis is the adhesion of the condyle of the mandible to the base of the skull. It is the most common cause of hypoplasia of the mandible and eventual facial asymmetry. This case report describes the management of unilateral bony re-ankylosis of temporomandibular joint after the failure of a costochondral graft in an eight-year-old girl. The management of temporomandibular ankylosis presents a major challenge due to its increased reoccurrence rate. In the present case, simultaneous gap arthroplasty and distraction osteogenesis were performed to separate the ankylotic mass and lengthen the ramus-condyle unit. The one year follow-up of the patient showed adequate mouth opening. We recommend concomitant gap arthroplasty and distraction osteogenesis for effectively managing temporomandibular joint bony ankylosis.
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