Background and objectives : The restoration of adequate length of the vertical ramus of the mandible followed ankylosis, trauma, ablation surgery and developmental abnormality is challenging. The methods, such as gap arthroplasty, interpositional arthroplasty, and joint reconstruction using autogenous graft or alloplastic materials, have been described in literature data. It is believed that one of the methods of successful reconstruction is costachondral graft transfer, and it seems to be gold standard for these purposes. Yet the simultaneous management of hard and soft tissue component of hemifacial asymmetry seems to be difficult. The aim of this study was attempt to improve postoperative outcomes by using of costachondral arthroplasty followed by distraction osteogenesis, which was based on preoperative virtual 3D planning.
Methods : The 3D preoperative planning was used for virtual costachondral graft harvesting, distraction device positioning, distraction protocol design and follow osteotomies simulation. The postoperative result was asses by clinical and cephalometry investigation as well as postoperative CT scan.
Results : No significant complications occurred and satisfactory functional and aesthetic results achieved. The adequate elongation of hard and soft tissue component of the hemifacial asymmetry was noted. Postoperative CT scan showed reasonable positioning of the chondral part of rib transplant within glenoid fossa and adequate elongation of graft and the mandibular body.
Conclusions : We found that the method could be perspective for adequate length restoration in case of hemifacial asymmetry and compromised TMJ function and anatomy. Key words : virtual planning; costachondral graft; distraction osteogenesis