panied with headaches. At the time of the rst visit, the patient was in full orthodontics and a conservative treatment of arthroscopy/arthrocentesis is completed. The patient continued follow-up with some increases in pain and progressing retrognathia noticeable during this pubertal period (. Fig. 29.3). Initial orthodon­tic treatment was completed within a year (completed at age of 15) with little symptom alleviation over that period. Throughout the patient’s growth period, pain was managed with dental splints and nonsteroidal anti- inammatories (NSAIDs). From 2014 to 2017, multiple arthroscopy/arthrocentesis procedures were performed to alleviate discomfort from additional dis­locations, jaw locks, and related pain. TMJ surgery was discussed as an option with the patient and fam­ily in annual follow- ups in 2015 and 2016. Because of the patient’s pain severity and progressing retrogna­thia of the skeletal morphology throughout puberty, the decision was made to proceed with CTOS with the objectives of achieving a functional airway and to restore the patient’s occlusion with optimal aesthetic harmonious positioning. Surgery planning was initi­ated when the patient was 17 years old (. Fig.29.4). Surgical risks were discussed and presurgical treat­ment education discussed requirements for periop­erative care. The patient was once again treated with orthodontics to regain level alignment prior to surgery (. Table 29.1). The virtual planning protocol was initiated to prepare for surgery as previously detailed (. Fig. 29.5). In 2017, the patient underwent sur­gery, which included reconstruction of custom-tted prosthesis, maxilla LeFort I counterclockwise rota-