Introduction: Temporomandibular joint ankylosis cases serve as a challenge for  both surgeons and anaesthesiologists. Trauma is the most common cause of TMJ  ankylosis, followed by infection. The management goal in TMJ ankylosis is to  increase the patient’s mandibular function, correct associated facial deformity, decrease pain, and prevent re-ankylosis. Case Report: A 9-year-old female presented with diffculty in mouth opening, leading to diffculty in maintaining oral hygiene. The patient had no comorbidities.  S he was diagnosed with left temporomandibular joint (TMJ) ankylosis and scheduled for left gap arthroplasty. On preoperative evaluation, vitals were stable, and systemic examination was  normal. Airway assessment revealed restricted mouth opening, trismus, left TMJ tenderness. Neck movements were unrestricted, but a Mallampati class IV airway  suggested diffculty.  Investigations were normal. She was premedicated .Induction was done using  Inj. Propofol 60 mg, followed by Inj. Atracurium 15 mg. After 3 failed attempts  with a Macintosh and video laryngoscope, intubation was achieved using a Miller  laryngoscope (size 0). Surgery lasted three hours with 150 mL blood loss. The patient remained stable intraoperatively and recovered uneventfully.  Conclusion: Anaesthesia management in patients with temporomandibular joint  ankylosis presents unique challenges, particularly in securing the airway and  maintaining hemodynamic stability during surgery. A thorough preoperative assessment and careful planning are essential for success. With appropriate
preparation and the ability to adapt to unexpected diffculties, the anaesthetic  management of TMJ ankylosis can be successfully navigated, minimizing  complications and ensuring optimal patient outcomes.