A 31 years-old, masculine sex, patient was referred from a low complexity health center to a medium complexity hospital, with a diagnose of “ Repeated third-molar pericoronitis ” and indication to perform the dental extraction of the affected tooth. The patient suffers Juvenile idiopathic arthritis, and he was medicated with Infliximab to control the pain inflicted by the disease. As a result of the Juvenile idiopathic arthritis the patient presents, bilateral TMJ ankylosis, limited jaw opening (8 mm apperture), vertebral fusion, difficult airway and ankylosis of other joint, other pathologies was unremarkable. This patient was evaluated by a multidisciplinary team and was decided to carry out the procedure that was initially indicated on a fast way, because previous episodes of pericoronitis were severe, with general compromise. The first obstacle was the airway and the incapacity to do a regular intubation, second, the limitation of mandibular movements, third, the medication that the patient was using restricts regular anesthesia protocols. The team decided to resolve this performing, a scheduled medication, and awake intubation with a fiberscope and a TMJ arthroplasty to release the mandible and break the ankylotic block, then made the dental extraction and a kinesic therapy to preserve the gap. In consecutive follow-ups the patient improved the jaw opening, and no signs of re-ankylosis was observated at one year to the operation.

Discussion: It is determinant to look with an integral view the patients to reach better results with programmed procedures and no emergency procedures to resolve the initial derivation of these patients.

Conflict of interest: None declared.