Rib Reconstruction of Absent Mandibular Condyles in Children

Abstract

Objective: 1) Describe pediatric costochondral graft reconstruction of the absent mandibular condyle. 2) Report the short-term and long-term outcomes and complications associated with performing this procedure in young children. Method: All children treated for an absent mandibular condyle with a costochondral graft from 2002 to 2011 at Children’s Hospitals and Clinics of Minnesota were identified and a retrospective chart review was performed. Outpatient charts, hospital records, and operative reports were reviewed. Results: Ten patients aged 3 to 11 years old were identified. The most common diagnosis in 7 out of 10 patients was oculo-auriculo-vertebral syndrome. Three of the patients had a tracheostomy, of which one was decannulated following condylar reconstruction. Functional improvement, defined as improved symmetry, chewing, or better oral opening, was observed in 8 out of 10 patients. Five patients have required no further surgeries to date, with a mean follow-up time of 3.9 years. Severe overgrowth of the graft was noted in 1 case and partial or complete resorption of the graft was also noted in 3 cases. Overgrowth occurred after 5.7 years whereas resorption occurred after an average of 2.5 years. Conclusion: Costochondral grafts are an excellent surgical treatment option for children with severe mandibular malformations. Short-term results show particular improvement in function and mandibular alignment. The mean follow-up time with no revision surgery was substantial and indicates that rib grafting is a good addition to the armamentarium of treatment for this patient population.