Aim and background: Zygomatico-coronoid ankylosis (ZCA) is a rare condition caused by fibrous or bony adhesion between the zygoma and coronoid process, which reduces normal mandibular movements, mostly of traumatic origin. In this case report, we aim to provide points on surgical management and the importance of postoperative physiotherapy. Case description: This report presents a case of a 34-year-old male with an operated zygomatico-maxillary complex (ZMC) fracture resulting in complete restriction of mouth opening. A computed tomography scan showed a unified bony mass between the zygoma and coronoid process. Surgical removal of the ankylosis was performed via a combined intraoral and conservative preauricular approach and contralateral coronoidectomy. Aggressive physiotherapy achieved a mouth opening of 38 mm at the 1-year follow-up. Conclusion: Our surgical resection technique of the ankylotic mass, which combined an intraoral and a conservative preauricular approach with early joint mobilization by aggressive physiotherapy, produced good functional and aesthetic results. Clinical significance: Surgical resection through an intra-oral and a conservative pre-auricular approach should be considered and if the zygomatico-coronoid ankylotic mass is moderately large and in long-standing cases a contralateral coronoidectomy may need to be performed to get adequate mouth opening. Aggressive postoperative physiotherapy and regular follow-up are mandatory to prevent re-ankylosis.