Background and objectives: Authors presents their experiences to solve the functional and aesthetic sequels and problems for Sawhney type IV or total TMJ ankylosis patients.

Methods: 15 patients between fifteen to seventy ages that had undergone for type IV ankylosis of TMJ were evaluated for previous surgical interventions, period for physiotherapy, additional surgeries, and improvement of respiratory functions, neurological sequels and aesthetics. The mainly performed surgical technique was gap arthroplasty.

Results: The mostly preferred technique was gap arthroplasty and spacer material was silicon materials for the previous interventions. For secondary revision surgeries rotational temporalis myofascia graft and total TMJ prosthesis were highly affective. The increased amount of previous intervention affects the neurological sequels (facial nerve). The respiratory functional results and aesthetic improved with the genioplasty operations. The average mouth opening increased up to 3 centimeters. The patients were highly satisfied.

Conclusions: The total TMJ prosthesis (Biomet) with fossa and ramus components after gap arthtoplasty with long term physiotherapy gave the best clinical outcome both for the patient and for the physician. The increased number of previous interventions showed increased number of facial nerve paralysis.

Key words: TMJ ankylosis; gap arthroplasty; total TMJ prosthesis