fig19

Figure 19. Pruzansky-Kaban Type III cases with joint reconstruction. (a) This patient underwent early joint reconstruction at the age of 4 but did not comply with physiotherapy and was lost to follow-up during the next 16 years. He returned with temporomandibular joint ankylosis and severe tooth decay; (b) the ankylosis was removed and a new costochondral graft was directed to the original fossa location; (c) frontal view immediately postoperatively of a patient who underwent late joint reconstruction. She had undergone surgery for plagiocephaly at a younger age. The joint was relocated more posteriorly and laterally. As a consequence, the rib graft was inclined at a 30° angle to the ascending ramus. Healing and postoperative physiotherapy were uneventful. A mouth opening range of 37 mm was obtained with full graft union; (d) three-fourths right profile view of the case in (c)