Osteoarthritis (OA) of the temporomandibular joint (TMJ) is a progressiveinflammatory disorder characterized by pain and reduced function.Treatment objectives for joint reconstruction should include themaintenance and restoration of form and function, and the reductionof pain. Many surgical approaches to the management of inflammatoryTMJ disease have been advocated and include high condylectomies,costochondral grafts with interpositional arthroplasties and alloplastictotal joint replacements.In recent years, total joint replacement with customized metal prostheseshas been strongly advocated in preference to other procedures as apredictable, long-term approach that satisfies many objectives for asuccessful reconstruction. However, mandibular protrusion and lateralexcursions on the involved sides are compromised and the long-termresults in young patients are still uncertain.The purpose of this presentation is to report the case of a femalewho underwent a mandibular advancement at age 16 years andsubsequently presented 16 years later at the age of 32 years withchronic bilateral TMJ pain but with full mandibular movements. She hadthe typical radiological signs of osteoarthritis. Her treatment involvedunilateral high condylectomies with temporalis muscle flap arthroplastieswith simultaneous routine sagittal section osteotomies to preserveher occlusion and maintain a full range of movement.It is proposed that this method may be an alternative approach inselected cases to avoid total joint replacement in young patients withthe maintenance of normal function.