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Costochondral grafting for paediatric temporomandibular joint reconstruction: 10-year outcomes in 55 cases

D H Awal1, M Jaffer1, G Charan1

  • 1Department of Maxillofacial Surgery, Great Ormond Street Hospital for Children, London, UK.

International Journal of Oral and Maxillofacial Surgery
|July 2, 2018
PubMed

Insights

Costochondral grafting (CCG) for pediatric temporomandibular joint (TMJ) reconstruction shows high complication rates, particularly ankylosis. Infection-related ankylosis significantly increases risks, advising caution in these cases.

Area of Science:

  • Oral and Maxillofacial Surgery
  • Pediatric Reconstructive Surgery
  • Biomaterials and Tissue Engineering

Background:

  • Costochondral grafting (CCG) is a common method for reconstructing temporomandibular joint (TMJ) defects in children.
  • While historically considered the gold standard due to autogenous origin and growth potential, CCGs present challenges like unpredictable growth and joint ankylosis.
  • Understanding long-term outcomes and complication rates is crucial for optimizing pediatric TMJ reconstruction strategies.

Purpose of the Study:

  • To evaluate the long-term efficacy and complication profile of costochondral grafts (CCGs) in pediatric temporomandibular joint (TMJ) reconstruction.
  • To identify risk factors associated with complications following CCG for TMJ defects in children.
  • To provide evidence-based recommendations for the use of CCGs in pediatric TMJ reconstruction.

Main Methods:

  • Retrospective study of pediatric patients who underwent CCG for TMJ reconstruction between 1985 and 2004.
  • Analysis of 74 grafts in 55 patients with a minimum 10-year follow-up period.
  • Statistical analysis to determine correlations between diagnoses, complications, and patient characteristics.

Main Results:

  • Overall complication rate was 58.2%, with ankylosis (32.7%) and overgrowth (16.4%) being most frequent.
  • Infection-related ankylosis showed a significant correlation with subsequent complications (P<0.005).
  • Congenital TMJ defects were associated with a lower complication rate compared to acquired defects (P<0.05).

Conclusions:

  • Costochondral grafting in pediatric TMJ reconstruction is associated with a high incidence of complications, notably ankylosis.
  • Caution is advised for CCGs in pediatric patients with pre-existing ankylosed TMJs, especially those with infection-related ankylosis.
  • The findings suggest a need for careful patient selection and consideration of alternative reconstructive methods for certain pediatric TMJ defects.

Keywords:
costochondral graftpaediatricreconstructiontemporomandibular joint

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