Clinical evaluation of growth potentiality of autogenous costochondral graft in Temporomandibular joint on New Zealand white rabbit- an experimental study

Background: Costochondral graft has been used as a substitute for a growth center in the damaged Temporomandibular joint (TMJ) in the growing children. But the relapse of the TMJ ankylosis along with facial deformity is the most common outcome after the surgery for the resorption or overgrowth of the graft. While an exploration of the human Temporomandibular joint seems to be unethical after reconstruction with an autogenous costochondral graft for study purposes, therefore we sought to determine the growth potential of the graft by clinical evaluation. Material and methods: An experimental study was done on 96 New Zealand white male rabbits, which were divided into batches. Each batch (total 2 batches) contained 24 experimental and 24 control rabbits of known ages and species; growing (3-4) and adult (12-18) months old. TMJ arthroplasty with a costochondral graft using either 1mm or 4 mm thickness of cartilaginous cap done in both age groups. Follow-up was done regularly in batches comparing with control up to 4th, 12th, and 24th weeks of surgery to find out any relationship of behavioral change, clinical presentation, and macroscopic growth of the graft. Results: There was a relationship among the rabbits with their behavioral change, clinical presentation, and presence of growth center in the graft. Growth was found in 60% cases, 40% was growing, and 20% in adults. Conclusions: Costochondral graft had a 60% growth potentiality. The failure rate of 40% may be due to some unknown factors. Grafts grew in a greater number of growing rabbits than adults. Long time follow-up had a strong role in the growth of the graft. In conclusion, clinical evaluation of the rabbit model provided a fair estimation of the growth process.

Sinonasal inflammatory myofibroblastic tumour: a rare entity with diagnostic challenges

Inflammatory myofibroblastic tumour is a rare entity causing sinonasal involvement with variable behaviour. Mimicking various benign and malignant lesions, accurate diagnosis is often clinched on histopathology complemented with appropriate immunohistochemistry markers. Surgical resection is the main treatment modality with other forms of therapy reserved for unresectable lesions. We highlight a case of dual involvement of the sinonasal region and nasal bones along with the diagnostic and treatment challenges encountered. As the nasal bones were involved, surgical resection with negative margins required cosmetic reconstruction in the same sitting. A costochondral graft helped in achieving cosmetic pleasing results with no recurrence on follow-up.

Comparison of Christensen Prosthesis System with Autogenous Costochondral Graft for Arthroplasty of Traumatic Temporomandibular Joint Dysfunction

N/A

Biomechanical analysis of costochondral graft fracture in temporomandibular joint replacement

This study is the first attempt to explore the reason of costochondral graft fracture after lengthy mandible advancement and bilateral coronoidectomy by combining finite element analysis and mechanical test. Eleven groups of models were established to simulate costochondral graft reconstruction in different degrees of mandible advancement, ranging from 0 to 20 mm, in 2 mm increment. Force and stress distribution in the rib-cartilage area were analyzed by finite element analysis. Mechanical test was used to evaluate the resistance of the rib-cartilage complex. Results showed a sharp increase in horizontal force between 8 and 10 mm mandible advancement, from 26.7 to 196.7 N in the left side, and continue increased after 10 mm, which was beyond bone-cartilage junction resistance according to mechanical test. Therefore, we concluded that bilateral reconstruction with coronoidectomy for lengthy mandible advancement (≥ 10 mm) may lead to prominent increase in shear force and result in a costal-cartilage junction fracture, in this situation, alloplastic prosthesis could be a better choice. We also suggested that coronoidectomy should be carefully considered unless necessary.

Mandibular Reconstruction Following Central Giant Cell Granuloma Resection in Primary Dentition: A Case for the Use of a Costochondral Graft

Central giant cell granuloma is a benign, intraosseous lesion that may affect the pediatric craniofacial skeleton, particularly the mandible. When surgery is indicated, the role of the craniofacial surgeon is to ameliorate the sequelae of ablative surgery by restoring facial symmetry, ensuring appropriate postoperative occlusion, and allowing for adequate interincisal opening, all in the setting of a growing craniofacial skeleton. Herein, we report the case of a 3-year-old female presenting for reconstruction after resection of the right hemimandible proximal to the unerupted first permanent molar. We highlight the various reconstructive challenges associated with mandibular reconstruction during primary dentition and make a case for the use of a costochondral graft, with a successful outcome demonstrated at 2 years of follow-up.