M Zeki Güzel1, Hakan Arslan, Mesut Saraç. 1. Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey. zg@e-kolay.net
Abstract
PURPOSE: Mandibular condyle reconstruction with free costochondral grafting is the most common method because of some advantages, such as its biological and anatomic similarities to the condyle, and growth potential in juveniles. Application techniques of the costochondral graft were reported in numerous articles with several advantages and disadvantages up to now. The purpose of this article is to present a new modification in application of the costochondral graft to the ramus of the mandible. This technique is pretty simple, but very effective. MATERIALS AND METHODS: The new technique described here consisted of a costochondral graft application for temporomandibular joint reconstruction, which was inserted into the medullary cavity of the mandibular ramus in 4 patients. This modification provided the graft placement as anatomical as the original condyle and further stabilized the graft in its position and inhibited its displacement without any fixation. This technique is pretty simple because an additional incision to the preauricular, facial nerve dissection, wide exposition and stabilization efforts are not required. RESULTS: Clinical and radiological evaluations on 14-month mean follow-up of 4 cases showed very satisfactory functional results with normal anatomic adaptation and configuration. In all cases, function of mandible was considered to be good with at least maximal interincisal opening of 30 mm. Good anatomical position of the graft and good bony healing were seen on the radiographs. Additionally, there was no need for postoperative intermaxillary fixation. CONCLUSION: With this technique, temporomandibular joint reconstruction by the costochondral graft can be performed as far as possible to the original condyle position.
PURPOSE: Mandibular condyle reconstruction with free costochondral grafting is the most common method because of some advantages, such as its biological and anatomic similarities to the condyle, and growth potential in juveniles. Application techniques of the costochondral graft were reported in numerous articles with several advantages and disadvantages up to now. The purpose of this article is to present a new modification in application of the costochondral graft to the ramus of the mandible. This technique is pretty simple, but very effective. MATERIALS AND METHODS: The new technique described here consisted of a costochondral graft application for temporomandibular joint reconstruction, which was inserted into the medullary cavity of the mandibular ramus in 4 patients. This modification provided the graft placement as anatomical as the original condyle and further stabilized the graft in its position and inhibited its displacement without any fixation. This technique is pretty simple because an additional incision to the preauricular, facial nerve dissection, wide exposition and stabilization efforts are not required. RESULTS: Clinical and radiological evaluations on 14-month mean follow-up of 4 cases showed very satisfactory functional results with normal anatomic adaptation and configuration. In all cases, function of mandible was considered to be good with at least maximal interincisal opening of 30 mm. Good anatomical position of the graft and good bony healing were seen on the radiographs. Additionally, there was no need for postoperative intermaxillary fixation. CONCLUSION: With this technique, temporomandibular joint reconstruction by the costochondral graft can be performed as far as possible to the original condyle position.