Mandibular ascending branch and condyle reconstruction in adolescence by a costochondral rib graft with an observation period over 8 years

Konstanze Scheller,Alexander W Eckert,Waldemar Reich,Christian Scheller

doi:10.1051/mbcb/2019029

Konstanze Scheller, Alexander W Eckert + Show 2 more

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https://doi.org/10.1051/mbcb/2019029

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Introduction: The need to resect and reconstruct the condylar process of the mandible in a teenager is rare. Reconstruction strategy must be accurately assessed in terms of donor side morbidity, postoperative risks (ankylosis) and the possibility of sufficient development in a growing patient. Observation: A 14-year-old boy presented with the radiographic finding of a large cystic lesion of the right condylar process. There were no clinical symptoms as pain, a limitation of mouth opening or malocclusion. Pathohistological examination confirmed a solitary bony cyst. The resected ascending jaw and condylar process was reconstructed by a costochondral rib graft. Commentaries: Over 8 years the development of the reconstructed ascending jaw and condyle was observed. There was an undisturbed growth. The cartilaginous part of the costochondral graft remodeled to a sufficient condylar process without ankylosis, resorption or overgrowth. Conclusion: The reconstruction of the growing mandible and condylar process in an adolescent is a challenge. Observation over 8 years showed a sufficient reconstruction. Intraoperative the chondral portion of the graft has to be handled carefully to avoid a separating from the bony part. The growth potential of the costochondral rib transplant allows a functional reconstruction without substantial donor side morbidity in adolescent patients.

Highlights

The need to reconstruct the condylar process of the mandible in a child or an adolescent is rare and in the literature especially described in the cases of ankylosis of the temporomandibular joint (TMJ) [1,2,3,4]
Solitary bone cysts are benign fluid-filled tumor-like bone lesions and more than 90% are located in the long bones, most commonly in the proximal humerus and femur [8]
In literature most needs for temporomandibular joint reconstruction (TMJ) in children are described in cases of craniofacial microsomia type III and posttraumatic ankyloses [1,3,8,18]

Summary

Introduction

The need to reconstruct the condylar process of the mandible in a child or an adolescent is rare and in the literature especially described in the cases of ankylosis of the temporomandibular joint (TMJ) [1,2,3,4]. If there is a need to resect and reconstruct the ascending mandibular part and condyle in a growing child or adolescent the following arguments have to be considered in therapy: a one-time therapy should lead to the cure and give the greatest possible chance of complete healing. The reconstruction of the condylar process in children or young adolescent is mainly influenced by the expected growth of the treated person.

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