Costochondral grafts had been used empirically for many years in the following ablative tumor surgery, correction of congenital and developmental deformities, treatment of ankylosis of joint. Anatomical or functional loss of the mandiblar condyle
and
eventually the ascending ramus and glenoid fossa, may be caused by trauma, infection, congenital dysplasia or surgery. Reconstruction of the temporomandibular joint (TMJ) is a challenging and sometimes frustrating aspect of oral and maxillofacial
surgery.
Over time, several techniques have used a variety of materials, both alloplastic and autogenous. The use of costochondral grafts for reconstruction of the TMJ was first described by Gillies in 1920. Since that time, costochondral grafting has
proven to
be a versatile procedure with a high rate of success.
@ES The treatment of the lost condyle must include the following requirements:
@EN 1. Restoration of vertical, protrusive and lateral movements of the mandible, to re-estabilish adequate mouth opening.
2. Restoration and maintenance of the vertical dimension, improvement of the dental occlusion and avoidance of postoperative apertognathia.
3. Restoration of facial symmetry, at rest and on movement, during and after cessation of growth.
4. Avoidance of recurrent ankylosis.
This paper reports the surgical and functional reults of the restrospective analysis of costochondral grafting. This clinical study was achieved to interesting results about mandibular movement, masticatory function, improvement of facial
disfigurement
and mandibular growth through long term followup in condylar reconstruction with autogenous costochondral graft for 10 patients who had undergone tumor, trauma, and TMJ ankylosis surgery. Condylar reconstruction with costochondral graft for
yields
satisfactory cosmetic and functional results in 4 adult patients. The long term follow up of 6 patients yields who had undergone costochondral grafting in the growing period was done. Three of the six patients yields more or less mandibular
undergrowth.
Two of the six patients developed normal mandibular growth. One of the these patients performed secondary condylectomy and orthognathic surgery because of severe mandibular overgrowth.
Conclusionally, condylar reconstruction with costochondral graft is recommended in adult, but must significantly consider due to unpredictable post-operative mandibular growth in growing child.
|