TMJ ankylosis is very common affliction in this part of the world which leads to fixation of TMJ leading to restricted or no mouth opening. It also causes gross facial deformity making the patient debilitated. It also leads to various psychological problems in these patients. This study consists of 20 patients having TMJ ankylosis who underwent pre arthroplastic vs simultaneous distraction followed for long term to see the merit and limitations of these two treatment modalities.