Management of Facial Asymmetry in TMJ Ankylosis and Degenerative Joint Disease

Temporomandibular joint (TMJ) pathology, particularly ankylosis and degenerative joint disease (DJD), can cause profound morphological changes in the mandible resulting in significant facial asymmetry. These pathologic anatomical changes are especially pronounced when they occur unilaterally and can be significantly worse when the insult occurs during the growing years of the patient’s life. The morphological changes caused by both ankylosis and DJD have the potential to disseminate their effects to surrounding facial soft tissues and bones, especially the maxilla, further complicating treatment. Unlike some other pathological causes of facial asymmetry, the cosmetic and asymmetric problems associated with ankylosis and DJD almost always come with debilitating functional problems, the combination of which may lead to malnourishment, depression, and an overall decreased quality of life. Proper management and surgical treatment of these patients must aim to correct both the functional and esthetic sequela associated with these pathologies.