Fate of Costochondral Graft in Ramus-Condylar Unit Reconstruction in Paediatric Temporomandibular Joint Ankylosis Patient

Objectives: The aim of this study was to analyse the fate of Costochondral graft (CCG) by evaluating the frequency of reankylosis ,resorption, fracture and growth status of graft in the paediatric temporomandibular joint (TMJ) ankylosis patients.

Materials and Methods: 23(12 male,11female) patients with unilateral or bilateral TMJ ankylosis who were operated between January 2014 to April 2018 included in the study. Mean age of study population was 9.6 ± 2 .8 years. Recurrent cases and patients with less than one year follow up were excluded. 27 CCGs were used in ramus condylar unit (RCU) reconstruction. Cartilage thickness was not more than 2-4mm in all cases. Fate of CCG was analysed clinically by checking the mouth opening(MO), occlusion at one month, 6 months, 12 months after that yearly once interval. Radiographically by measuring tentative CCG height in orthopantomogram (OPG) and condylion to gnathion distance in posteroanterior cephalogram , which were taken at immediate and last follow up period. Based on OPG, resorption was categorized into complete, partial and no resorption.

Results: 26 (97%) CCG survived in follow up of 12-48months (mean17.8 months).The postoperative mouth opening was (31.6 ± 5.1mm) which was statistically significant (p value- 0.001). Reankylosis was seen in one graft. Partial resorption in two grafts, fracture noticed in two grafts. On evaluating the growth status of CCG, 15 grafts (55.5%) had optimum growth, 11 grafts (40.74%) had suboptimum growth , one graft (3.7%) had overgrowth.

Conclusion: 97% survival of CCG and ability of growth makes CCG the choice of autogenous RCU reconstruction modality in pediatric TMJ ankylosis as it helps in maintaining ramal length and mouth opening in non-recurrent cases. Successful clinical outcome is achieved by keeping the thickness of cartilage 2-4mm and regular follow up and active mouth opening exercise postoperatively helps in reducing chances of reankylosis.