Costochondral grafts (CCGs) as growth sites: how useful are they?

Objective: CCGs have long been used to reconstruct the RCU in children and young adults following resection of diseased bone (ankylosis, tumour) or in cases of condylar aplasia, due to their enormous growth potential. The aim of our study is to determine the efficacy/accuracy of CCGs in such reconstruction.

Materials and method: In the last 10 years, 65 patients between the ages of 7 and 16 years have been treated by RCU reconstruction with CCG at our centre. In all patients CCG with a 3–5 mm cartilaginous cap was used, either unilaterally (U/L) or bilaterally (B/L) as the case warranted. The graft was fixed to the ramal stump with 2 screws. At follow up appointments, the following parametres were noted: mouth opening, symmetry of face, re-ankylosis, hypertrophic scar and facial nerve weakness. Additionally, pain, regeneration of bone and damage to mammary gland were assessed clinically, with photographs and radiographs.

Results: Out of the total 65 cases, 55 were treated with U/L reconstruction and 10 with B/L reconstruction. The mean post-operative mouth opening in these patients was noted to be 32 mm. Out of the 55 U/L cases, 16 showed normal growth, whereas lateral over growth was seen in 3 patients and 36 patients showed less/no growth compared to the normal growing side. In the 10 B/L cases, improvement in facial aesthetics was seen in 4 patients with no changes seen in 6 patients. Each of the U/L and B/L cases showed re-ankylosis.

Conclusion: The above findings suggested that even though CCG has tremendous growth potential in growing children, its behaviour is non predictable irrespective of age, sex and thickness of cartilage. So distraction has become a preferred option over grafting with any autogenous material, for growth and reconstruction of RCU, hence avoiding unpredictability and a second surgical site.

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Costochondral grafts (CCGs) as growth sites: how useful are they?
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