Facial lawn mower injury treated by a vascularized costochondral graft

Abstract

Mandibular defects present a difficult condition to treat, especially when the condyle is involved. The method chosen for reconstruction of the missing ramus and condyle must provide facial symmetry and a functional joint. In children, there is an additional requirement of allowing facial growth to proceed normally. Autogenous costochondral rib grafts have been accepted as a satisfactory replacement for mandibular rami and condyles in adults as well as children. 1,2 Several studies have shown that in children costochondral grafts have the potential to grow. However, the growth of these grafts is unpredictable, ranging from resorption to overgrowth. 3–6 In 1989, Poole 7 reported the use of vascularized soft tissues in the early surgical treatment of children with hemifacial microsomia. Although it is expected that vascularized costochondral grafts may provide more predictable growth than nonvascularized free grafts, this potential advantage has still to be demonstrated. This article presents the surgical treatment and follow-up of a case with an extensive facial defect caused by a riding lawn mower injury. The patient was treated with a composite transfer of a vascularized costochondral rib graft with associated soft tissue.