{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:18:07Z","timestamp":1790615887564,"version":"4.1.0"},"reference-count":21,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,31]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>An early adolescent with bilateral temporomandibular joint (TMJ) ankylosis presented with obstructive sleep apnoea (OSA), facial asymmetry and reduced mouth opening with an interincisal distance of 2\u2009mm. Baseline polysomnography (PSG) revealed a critically elevated apnoea\u2013hypopnoea index (AHI) of 90.3, consistent with extremely severe OSA. Due to high anaesthetic risk and compromised airway, a staged surgical approach was adopted. A planned tracheostomy was performed during the first-stage procedure to secure the airway with subsequent bilateral mandibular distraction osteogenesis leading to significant improvement in OSA symptoms, nutritional status and airway dimensions. Four months later, bilateral TMJ ankylosis release and interpositional gap arthroplasty using dermis fat were performed. Tracheostomy was maintained for approximately 175 days to ensure airway safety during the interval between staged procedures and because of the anticipated difficulty with reintubation for the subsequent surgery. Postoperatively, the unassisted interincisal opening improved to 35\u2009mm. No postoperative device-related or neurological complications were reported. Decannulation was performed after confirmation of adequate airway patency. Repeat PSG performed at 1 year follow-up demonstrated an AHI of 0.6. This report illustrates the effectiveness of a staged approach in managing TMJ ankylosis complicated with severe OSA. In this case, airway management is a point of practical importance for surgical planning due to anticipated difficult intubation and intraoperative risk.<\/jats:p>","DOI":"10.1136\/bcr-2025-271540","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:31:18Z","timestamp":1790613078000},"page":"e271540","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Unlocking the airway through mandibular distraction followed by TMJ release in bilateral TMJ ankylosis complicated by severe OSA"],"prefix":"10.1136","volume":"19","author":[{"given":"Adil","family":"Gandevivala","sequence":"first","affiliation":[{"name":"Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India"},{"name":"Cleft and Craniofacial Unit, MGM Dental College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srivalli","family":"Natarajan","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India"},{"name":"MGM Dental College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitesh Dinesh","family":"Patkar","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6996-7533","authenticated-orcid":false,"given":"Charlotte","family":"Saldanha","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"2026092809301082000_19.9.e271540.1","first-page":"4888","article-title":"Mandibular distraction osteogenesis in the treatment of pediatric temporomandibular joint ankylosis with micrognathia and obstructive sleep apnea syndrome: A case report with 4-year follow-up","volume":"18","author":"Yu","year":"2019","journal-title":"Exp Ther Med"},{"key":"2026092809301082000_19.9.e271540.2","doi-asserted-by":"crossref","DOI":"10.1007\/s11892-021-01426-z","article-title":"Sleep Apnea and Cardiovascular Disease","volume":"21","author":"Gottlieb","year":"2021","journal-title":"Curr Diab Rep"},{"key":"2026092809301082000_19.9.e271540.3","doi-asserted-by":"crossref","DOI":"10.1111\/jsr.12855","article-title":"Mortality-risk-based apnea-hypopnea index thresholds for diagnostics of obstructive sleep apnea","volume":"28","author":"Korkalainen","year":"2019","journal-title":"J Sleep Res"},{"key":"2026092809301082000_19.9.e271540.4","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/14.6.540"},{"key":"2026092809301082000_19.9.e271540.5","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31816d83e4"},{"key":"2026092809301082000_19.9.e271540.6","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s10006-018-0722-x","article-title":"Pre-arthroplastic mandibular distraction osteogenesis for the correction of OSA in TMJ ankylosis: a prospective observational study of 25 cases","volume":"22","author":"Andrade","year":"2018","journal-title":"Oral Maxillofac Surg"},{"key":"2026092809301082000_19.9.e271540.7","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.bjoms.2023.11.009","article-title":"Does distraction osteogenesis improve the airway volume and quality of life of obstructive sleep apnoea patients secondary to temporomandibular joint ankylosis?","volume":"62","author":"Chaudhary","year":"2024","journal-title":"Br J Oral Maxillofac Surg"},{"key":"2026092809301082000_19.9.e271540.8","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.jcms.2013.07.031","article-title":"Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint","volume":"42","author":"Yadav","year":"2014","journal-title":"J Craniomaxillofac Surg"},{"key":"2026092809301082000_19.9.e271540.9","doi-asserted-by":"publisher","DOI":"10.1016\/0278-2391(90)90529-B"},{"key":"2026092809301082000_19.9.e271540.10","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.022427","article-title":"Sleep-Disordered Breathing and Cardiovascular Disease in Children and Adolescents: A Scientific Statement From the American Heart Association","volume":"10","author":"Baker-Smith","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2026092809301082000_19.9.e271540.11","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.bjoms.2024.08.003","article-title":"Triad of temporomandibular joint ankylosis, micrognathia, and obstructive sleep apnoea: a systematic review of surgical management","volume":"62","author":"Yew","year":"2024","journal-title":"Br J Oral Maxillofac Surg"},{"key":"2026092809301082000_19.9.e271540.12","article-title":"Temporomandibular Joint Ankylosis: Anesthetic Challenge","volume":"16","author":"Bhalerao","year":"2024","journal-title":"Cureus"},{"key":"2026092809301082000_19.9.e271540.13","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.jobcr.2019.06.008","article-title":"Airway challenges in bilateral temporomandibular joint ankylosis with adenoid hypertrophy: a case report","volume":"9","author":"Jain","year":"2019","journal-title":"J Oral Biol Craniofac Res"},{"key":"2026092809301082000_19.9.e271540.14","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1597\/1545-1569_1999_036_0269_mlbdoi_2.3.co_2","article-title":"Mandibular lengthening by distraction osteogenesis in children--a one-year follow-up study","volume":"36","author":"Huang","year":"1999","journal-title":"Cleft Palate Craniofac J"},{"key":"2026092809301082000_19.9.e271540.15","doi-asserted-by":"crossref","first-page":"84","DOI":"10.5005\/jp-journals-10069-0162","article-title":"Temporomandibular Joint Ankylosis Leading to Obstructive Sleep Apnea Treated with CPAP Pressure Therapy","volume":"20","author":"Kumar","year":"2025","journal-title":"Indian J Sleep Med"},{"key":"2026092809301082000_19.9.e271540.16","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jobcr.2015.06.003","article-title":"Pre-arthroplastic and simultaneous mandibular distraction for correction of facial deformity in temporomandibular joint ankylosis","volume":"5","author":"Chellappa","year":"2015","journal-title":"J Oral Biol Craniofac Res"},{"key":"2026092809301082000_19.9.e271540.17","doi-asserted-by":"crossref","first-page":"298","DOI":"10.4103\/ams.ams_208_20","article-title":"Controversies in the Management of Temporomandibular Joint Ankylosis Using Distraction Osteogenesis - A Systematic Review","volume":"11","author":"Albert","year":"2021","journal-title":"Ann Maxillofac Surg"},{"key":"2026092809301082000_19.9.e271540.18","doi-asserted-by":"crossref","first-page":"332","DOI":"10.7555\/JBR.29.20140073","article-title":"Distraction osteogenesis for correction of post ankylosis mandibular deformities","volume":"29","author":"Khan","year":"2015","journal-title":"J Biomed Res"},{"key":"2026092809301082000_19.9.e271540.19","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2017.00533","article-title":"Definition and Diagnosis of the Trigeminocardiac Reflex: A Grounded Theory Approach for an Update","volume":"8","author":"Meuwly","year":"2017","journal-title":"Front Neurol"},{"key":"2026092809301082000_19.9.e271540.20","doi-asserted-by":"crossref","first-page":"25","DOI":"10.4103\/0975-5950.102146","article-title":"An epidemiological study of temporomandibular joint ankylosis","volume":"3","author":"Gupta","year":"2012","journal-title":"Natl J Maxillofac Surg"},{"key":"2026092809301082000_19.9.e271540.21","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.coms.2014.09.003","article-title":"Management of temporomandibular joint ankylosis","volume":"27","author":"Movahed","year":"2015","journal-title":"Oral Maxillofac Surg Clin North Am"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271540","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:31:21Z","timestamp":1790613081000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271540"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":21,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,28]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2025-271540"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271540","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}