Clinical Presentations of Temporomandibular Joint Ankylosis in Children and Their Association with Sawhney Classification: A Cross-Sectional Study

Background: Temporomandibular joint (TMJ) ankylosis in children is a debilitating condition characterized by restricted mandibular movement, often resulting in facial asymmetry, malocclusion, feeding difficulties, and impaired speech due to disruption of normal craniofacial growth. Objective: To determine the frequency of clinical presentations of TMJ ankylosis in children and to evaluate their association with Sawhney radiographic classification. Methodology: This descriptive cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, from August 2022 to February 2023. A total of 77 children aged 1–18 years with clinically and radiographically confirmed TMJ ankylosis were enrolled using non-probability consecutive sampling. Maximum mouth opening (MMO) was measured as maximal interincisal distance and categorized into severity levels. Facial asymmetry and malocclusion were assessed using predefined clinical criteria. Radiographic classification was performed using Sawhney Types I–IV based on the best available imaging modality (OPG/CT/CBCT). Results: The mean age of participants was 8.48 ± 4.85 years. Severe limitation of MMO was observed in 45.5% of cases, facial asymmetry in 51.9%, and malocclusion in 76.6%. Sawhney Type I was the most frequent (32.5%), followed by Type IV (26.0%). Significant associations were observed between Sawhney classification and MMO severity (p<0.001; Cramer’s V=0.44), facial asymmetry (p<0.001; Cramer’s V=0.53), and malocclusion (p<0.001; Cramer’s V=0.48). Age-stratified analysis demonstrated a decreasing trend in severe clinical manifestations with increasing age. Conclusion: Pediatric TMJ ankylosis commonly presents with severe functional limitation and dentofacial deformities. Strong clinico-radiologic associations highlight the relevance of Sawhney classification in reflecting disease severity at presentation. Keywords: Children; Mouth opening, Facial asymmetry, Malocclusion, Sawhney classification, Temporomandibular joint ankylosis.