Unpredictable growth pattern of costochondral graft

Area of Science:

• Oral and Maxillofacial Surgery
• Pediatric Plastic Surgery
• Regenerative Medicine

Background:

• Costochondral grafts are increasingly used for temporomandibular joint (TMJ) and condyle reconstruction in pediatric patients.
• Indications include hemifacial microsomia and trauma-related TMJ ankylosis.
• Long-term outcomes and growth predictability remain areas of concern.

Purpose of the Study:

• To evaluate the long-term growth patterns and complications of costochondral grafts in adolescent TMJ reconstruction.
• To analyze the effects of graft growth on mandibular and maxillary development.
• To provide recommendations for optimizing surgical outcomes.

Main Methods:

• Long-term follow-up study of eight adolescent patients undergoing TMJ and ramus reconstruction using costochondral grafts.
• Patients had diagnoses of hemifacial microsomia or posttraumatic TMJ ankylosis.
• Average follow-up duration was 80.4 months.

Main Results:

• Graft growth was highly unpredictable: four patients experienced excessive growth, one had suboptimal growth, and three had no significant growth.
• One patient required four revision surgeries due to severe graft overgrowth.
• Ankylosis developed in some cases, often associated with graft ossification and overgrowth beyond the cartilage boundary.
• Vertical mandibular growth influenced maxillary vertical growth, but horizontal maxillary growth was unaffected.

Conclusions:

• Costochondral graft growth in TMJ reconstruction is unpredictable, with mandibular overgrowth and ankylosis being significant complications.
• Graft overgrowth can be more problematic than growth deficiency.
• The procedure should be reserved for severe skeletal deficiencies.
• Recommendations include preserving soft tissue interposition and harvesting grafts from the 4th or 5th rib to mitigate overgrowth potential.