Staged therapeutic approach for rehabilitation of severe asymmetric Class II dentofacial deformity secondary to long standing unilateral temporomandibular joint ankylosis Harpreet Singh 1 , Sonal Mishra 2 , Dhirendra Srivastava 2 , Pranav Kapoor 1 , Poonam Sharma 1 , Lokesh Chandra 2 1. ESIC Dental College and Hospital, Department of Orthodontics and Dentofacial Orthopedics, Sector 15, Rohini, 110089 Delhi, India 2. ESIC Dental College and Hospital, Department of Oral and Maxillofacial Surgery, Sector 15, Rohini, 110089 Delhi, India Correspondence: Sonal Mishra, ESIC Dental College and Hospital, Department of Oral and Maxillofacial Surgery, Sector 15, Rohini, 110089 Delhi, India. sonal.816@gmail.com Available online: 24 June 2019 Keywords Temporomandibular joint ankylosis Class II deformity Staged therapeutic approach Distraction osteogenesis Orthognathic surgery Orthodontics Summary Despite being one of the most pervasive debilitating skeletal problems in the craniofacial region, surgical-orthodontic management of long-standing asymmetric Class II dentofacial deformities is often a unique challenge posed to the clinicians. This case report describes the encouraging results of systematically sequenced and staged therapeutic approach adopted for successful rehabilitation of an adult patient with asymmetric Class II dentofacial deformity with mandibular micrognathia secondary to unilateral TMJ ankylosis. Concurrent gap arthroplasty and bilateral distraction of mandibular body were performed during the first operation for functional restoration of mandib- ular movements and correction of mandibular micrognathia and associated asymmetry. After 13 months of post-distraction orthodontic treatment, Le Fort I osteotomy for inferior repositioning and sagittal advancement of maxilla was performed during the second operation, in conjunction with adjunctive alloplastic reconstruction of inferior border of mandible for optimization of facial aesthetics. Postsurgical orthodontic detailing facilitated achievement of stable, balanced interdig- itation. The total active treatment period was 29 months. After treatment, both the skeletal disharmony and the functional stability were significantly improved with establishment of functional occlusion. The morphological and functionally acceptable results were reasonably well-maintained during three-year follow-up. The merits of mandibular osteodistraction vs. conventional mandibular orthognathic surgery and the potential advantages of staged surgical approach are discussed. tome 17 > n83 > September 2019 https://doi.org/10.1016/j.ortho.2019.06.020 © 2019 CEO. Published by Elsevier Masson SAS. All rights reserved. 580 Case report International Orthodontics 2019; 17: 580–595 Websites: www.em-consulte.com www.sciencedirect.com