TMJ ankylosis is a serious and disabling condition especially in children that may cause problems in mastication, digestion, speech, appearance, mandibular growth and oral hygiene. Post operative physiotherapy has been difficult to achieve in children.We are describing a new technique of using ultrathin silicon sheet for management of recurrent TMJ ankylosis in children followed by intensive physiotherapy using custom made dynamic jaw exerciser. 10 children aged 6–15 years with unilateral post traumatic or congenital ankylosis were followed up for minimum of one year after surgery.

Result: The pre-operative mouth opening varied from 2 mm to 10 mm. The intra-operative mouth opening achieved ranged 3–4 cm. There was no extrusion of the implant in immediate and follow-up period in any of our patients. There was no recurrence during the follow-up period ranging from 1 year to 2 years.

Conclusions: Reconstruction of articular disc, preserving mandibular height and active physiotherapy is cornerstone for successful treatment. Ultrathin silicone sheet interposition arthroplasty is a good treatment option for recurrent and complicated cases in children. Minimal loss of mandibular height and permanent reconstruction of articular disc not only prevents further facial deformity but also reduces recurrence. Dynamic jaw exerciser allows painless active physiotherapy.