The Inverted Coronoid-Ramus Graft for Condylar Reconstruction

Area of Science:

• Oral and Maxillofacial Surgery
• Regenerative Medicine
• Biomaterials Science

Background:

• Mandibular condyle defects require effective reconstruction methods.
• Existing techniques may have limitations in graft resorption and functional outcomes.
• Autogenous bone grafts are a common solution, but versatility and resorption resistance are key.

Purpose of the Study:

• To describe a creative and versatile technique for condylar reconstruction using autogenous mandibular bone.
• To evaluate the efficacy and outcomes of the inverted coronoid graft technique for specific mandibular defects.
• To highlight the advantages of this technique in terms of versatility, reduced operative time, and minimal scarring.

Main Methods:

• Excision of the ipsilateral coronoid process-mandibular ramus.
• Inversion and 180° rotation of the excised segment to replace the condyle.
• Graft fixation using vestibular and preauricular or endaural incisions, often with virtual surgical planning.

Main Results:

• Successful reconstruction of small condyle and/or ramus defects (35-40 mm).
• Graft demonstrated resistance to resorption compared to endochondral bone grafts.
• Four cases showed no adverse functional results (e.g., ankylosis, hardware removal, adverse remodeling) over an average 21-month follow-up.
• Achieved mean post-reconstruction opening of 40.5 mm.

Conclusions:

• The inverted coronoid graft is a versatile and effective technique for mandibular condyle reconstruction.
• It offers advantages such as reduced operative time, minimal scarring, and good functional outcomes.
• Virtual surgical planning enhances the feasibility and precision of this reconstructive approach.