Unilateral pathology leads to asymmetry and severe growth deficiency of the facial skeleton.
In three out of these four cases unilateral TMJ-ankylosis occurred following condylar fractures in 2nd or 3rd year of life. After release of the ankylosis, reconstruction of the TMJ with a costochondral graft was performed in a second stage operation together with complementary osteotomies to reposition the tilted occlusal plane. Intermaxillary wire fixation was employed for about 2 weeks. The costochondral graft can be fixed by a mini-plate to the ascending ramus. This way a very exact vertical alignment can be achieved.