 Hello, I am Dr. Abhay Kamath, consultant maxillofacial surgeon at the Department of Maxillofacial Surgery KMC Hospitals Ambedkar Circle. Today we have joined here to provide some information about total joint replacements being conducted at Ambedkar Hospitals Mangalore. We recently had a boy aged 7 years who presented to the maxillofacial OPD with a chief complaint of inability to open the mouth. On eliciting history, the mother gave a brief history saying that the child was already operated 4-5 times with recurrent phases of ankylosis forming again and the child undergoing 5 surgeries for correction of the same. The child also presented with significant amount of sleep apnea because of the underdevelopment of the jaws and the repeated surgeries which had led to shortening of the vertical ramus. So as a surgeon, where I have specialized in alloplastic joint reconstructions, what came into my mind was rather than doing the same conventional approach of increasing the length as well as the width of the mandible, by doing a costocondal grafting or a distraction osteogenesis where we tend to increase the length of the mandible in an anterior posterior or in a plane which helps improve the breathing. I thought out of the box a joint replacement would be a better option and since the child was already operated many a times with all modalities including distraction osteogenesis as well as costocondal grafting and the child was also diagnosed to be an MRSA positive that is methicillin resistant staph arias and hospital acquired infection. We had to take in a lot of care to see what would be the final treatment plan. So initially we came up with all the primary investigations and we thought about why not go ahead with the conventional but the bells which rang in our mind was by doing the conventional approach, we would again subject the child to the same old conventional treatment whether it is distraction or costocondal grafting and added issue was the MRSA. So the final plan what we came up with was an alloplastic bilateral TMG replacement or a partial counterclockwise rotation of the mandible, improve the patient's airway and also give him back his facial functions and aesthetics. So we did the initial planning, got the CT scans done, got a polysomnography study done as well as a CT NGO. The CT scans of the patient were processed and sent to United States of America Jacksonville and the joints have been manufactured by Zimmer Biomet. Zimmer has their own standard set of joints what we call the stock joints which are freely available in the market. But since this child had specific requirements we went in for what is called as patient specific implants or PSI for bilateral replacement of the temporal mandibular joints. Once the joints came back from the US the child was subjected to bilateral TMG replacement. Initially the child presented to us with nil mouth opening and believe me all these surgeries when I speak about bilateral TMG replacements it's a combined team effort. When I say team effort it involves anesthetists, it involves pediatricians, co-colleagues as well as respiratory or pulmonologists as the duration of surgery is around 8 to 9 hours and it does take at all on the ventilation. So the child was subjected to the surgery wherein we did a bilateral TMG replacement. Once the child underwent the bilateral TMG replacement what we found post-operatively was that the mouth opening improved from 0 to 25 and today as of things stand the child is doing well, he's put on weight, he's got back his functional ability as well as the aesthetics which is desired for a child of that age. I'm sure we would think about what is the fate of these joints at the later age when the child grows, yes probably he might require an additional surgery at the age of 19 years when he grows in the form of an osteotomy for the upper jaw. And I'm happy to say that we at KMC hospitals, Mangalore, Ambedkar Circle possibly are the first hospital in India to conduct bilateral alloplastic TMG replacement in India and possibly in the known English literature one of the few very hospitals in the world to carry out this complex surgery taking into consideration the age of the patient and the procedure per se the delicacy what I mean. I wish all the best to all my patients through this video all I would like to encourage is that there is a treatment for temporal mandibular joint afflictions at KMC hospitals Mangalore in a wide array of specializations made be from distractions to costocondal graftings to the new possibly the bombshell in the armamentarium being alloplastic TMG replacements. Thank you.