Coronoid Process Grafts Research Articles

Recurrence-Related Factors of Temporomandibular Joint Ankylosis: A 10-Year Experience

The treatment of temporomandibular joint (TMJ) ankylosis can be challenging for surgeons because of technical difficulties and a high incidence of recurrence. In the present study, we reviewed the data from patients with TMJ ankylosis during a 10-year period and explored the risk factors for recurrence. A retrospective cohort study was conducted to review the data from patients with TMJ ankylosis from January 1, 2006 to December 31, 2015. The predictor variables were age, TMJ ankylosis classification, and treatment method. The primary outcome variable was the recurrence rate of TMJ ankylosis during follow-up. The χ2 test or Fisher exact test was performed to analyze the differences in the recurrence rate. A total of 130 patients (59 females and 71 males; age, 3 to 67years) were included in the present study. All the patients were divided into 3 groups according to their age. The rate of joint reankylosis among the children was 19.1%, which was significantly greater than that of the adults (7.3%; P<.05). In the adults, the joint was reconstructed using a coronoid process graft (CPG), distraction osteogenesis, or prosthesis implantation for type III. Among these treatments, CPG resulted in the greatest recurrence rate (26.7%). Children with ankylosis were found to be more prone to recurrence compared with adults. TMJ ankylosis was also more likely to recur in adults undergoing reconstruction with a CPG.

The coronoid process graft: A new revolution in management of temporomandibular joint ankylosis

Objectives: The aim of the present study is to compare the clinical outcomes of the widely used autogenous costochondral grafts with autogenous coronoid process grafts for condylar reconstruction in treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults.Patients and Methods: Nine patients of unilateral TMJ ankylosis in age group older than 18 years were selected from the outpatient clinic of the Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, they were 6 males and 3 females, the condyle was reconstructed after gap arthroplasty in 4 patients with costochondral grafts and with coronoid process graft in 5 patients. Clinical and radiographic examination was done postoperatively to compare between the 2 groups.Results: The clinical outcomes in both groups were satisfactory and comparable with no significant differences between the 2 groups in the measurements before and after the operation regarding mouth opening, lateral excursion and mandibular deviation. Complications related to the donor site were much higher in the costochondral group.Conclusion: Autogenous coronoid process is a promising alternative graft to the traditional costochondral graft for condylar reconstruction in adult patients with TMJ ankylosis.

Grafts of autogenous coronoid process to reconstruct the mandibular condyle in children with unilateral ankylosis of the temporomandibular joint: long-term effects on mandibular growth

Injury to the mandibular condyle in children usually leads to malocclusion and disharmony of facial growth. Our aim was to study the facial growth after reconstruction of the mandibular condyle using autogenous coronoid process grafts in children with unilateral ankylosis of the temporomandibular joint (TMJ). We followed up 10 growing patients with unilateral bony ankylosis of the TMJ who had been admitted to the West China Hospital of Stomatology, Sichuan University (Chengdu, China) between 1 January 2008 and 31 December 2012. There were three boys and seven girls, age range 5–12 years at the time of operation. In each case, patients were treated by gap arthroplasty, reconstruction of the condyle with an ipsilateral coronoid process, and interposition of the pedicled temporalis fascial flap during one operation. The mean (range) postoperative follow up was 4.73 (3–6) years. Postoperative panoramic radiographs were taken, and the growth of the mandibular height and length on the affected side was measured and compared with the healthy side. All patients had an uneventful, normal recovery. The mean (range) maximal mouth opening at the end of follow up was 35.6 (32–41) mm. Both the height of the ramus and the length of the mandible continued to grow after successful treatment of the ankylosis (using autogenous coronoid process grafts for reconstruction of the condyle) but the deficit in growth was not completely made up. The final height of the ramus on the affected side (at the end of follow up) had increased by 25% (p=0.012) and the final length of the mandible on the affected side by 26% (p=0.010) compared with immediately after operation. For comparison of the rate of growth, the increased height of the ramus of the affected side was 47% lower (p=0.003), while the increased length of the mandible on the affected side was 27% shorter (p=0.008) compared with the healthy side. The mandible on the affected side continued to grow after successful treatment of the ankylosis, but the growth deficit was not made up completely. The rate of growth of the affected mandible seemed to be less than on the undisturbed side even after treatment of the ankylosis.

Maxillary Reconstruction Using Submental Artery Island Flap and Sagittal Mandibular Ramus/Coronoid Process Graft Pedicled With Temporalis Muscle

The purpose of this study is to describe maxillary reconstruction using the submental artery island flap and the sagittal mandibular ramus and coronoid process graft pedicled with the temporalis muscle through the modified lateral lip and submandibular approach. From May 2013 to September 2016, 11 patients with maxillary defects secondary to maxillary cancer ablation who underwent maxillary reconstruction using a submental artery island flap and a sagittal mandibular ramus and coronoid process graft pedicled with the temporalis muscle through the modified lateral lip and submandibular approach were enrolled in this prospective study. All submental artery island flaps and sagittal mandibular ramus and coronoid process grafts were successful, with satisfactory functional and esthetic outcomes. No functional impairment at the donor site occurred in any case. The submental artery island flap combined with the sagittal mandibular ramus and coronoid process graft is a feasible and acceptable technique for maxillary reconstruction in older patients because it is safe, quick, and straightforward to harvest and it offers a very acceptable esthetic and satisfactory outcome, with the advantage of low morbidity of the donor site. When combined with the 3-dimensional virtual operative method, the technique can improve postoperative outcomes.

Cone-beam computed tomography evaluation of the maxillofacial features of patients with unilateral temporomandibular joint ankylosis undergoing condylar reconstruction with an autogenous coronoid process graft.

ObjectiveTo evaluate the changes in the jaws and the upper airways of unilateral temporomandibular joint ankylosis patients who underwent condylar reconstruction via autogenous coronoid process grafts using cone-beam computed tomography (CBCT).Study designThe 27 included patients underwent CBCT examinations at three stages: T0 (within two weeks before surgery), T1 (two weeks after surgery), and T2 (an average of 13 months after surgery). Forty items related to the maxillofacial hard tissues and the upper airway collected at the three times and the coronoid process graft volumes after surgery were compared.ResultsSome integral items related to the mandibular hard tissues exhibited statistical difference shortly after surgery. Some integral items related to maxillofacial hard tissues changing obviously long period after surgery may result from graft remodeling. Asymmetry-related item regarding local neo-condyle and some airway items were significantly different between T0 and T1. Due to variations in graft remodeling, some related local asymmetry items and airway items differed significantly between T0 and T2.ConclusionsAnteriorly and inferiorly located neo-condyles and a trend toward the pronation of the mandible were observed and the narrowness of the upper airway was improved shortly after surgery. The grafts remodeled differently and some integral and asymmetry items related to neo-condyle changed. The improvements in the upper airway were slightly reduced.

A comparative study of different surgical methods in the treatment of traumatic temporomandibular joint ankylosis

Two different surgical methods for the treatment of unilateral traumatic temporomandibular joint (TMJ) ankylosis with a medially displaced residual condyle are described. Eighteen patients with unilateral traumatic TMJ ankylosis and a medially displaced residual condyle, treated between 2008 and 2013, were included in this study. Group A patients (n=10) were treated with an autogenous coronoid process graft (ACPG) for reconstruction of the mandibular condyle, while group B patients (n=8) were treated by lateral arthroplasty (LAP); a temporalis myofascial flap (TMF) was used as interpositional material in both groups. The long-term results of the two treatments were compared through postoperative computed tomography and clinical follow-up examinations. The two groups were compared in terms of the recurrence rate, facial pattern change, and improvement in maximum inter-incisal opening (MIO) using SPSS 18.0 software. All patients were followed up for 12–24 months. Two patients in group A (20%) had reankylosis; no reankylosis was observed in group B patients. Compared with the ACPG, LAP improved the facial pattern and MIO significantly (P<0.05). LAP is a feasible and effective surgical method for the treatment of unilateral traumatic TMJ ankylosis when the displaced residual condyle is bigger than one third of the condylar head.

Coronoid process and residual ankylotic mass as an autograft in the management of ankylosis of the temporomandibular joint in young adolescent patients: a retrospective clinical investigation

The aim of this non-randomised investigation was to assess the feasibility of using autogenous grafts (such as coronoid process and the resected ankylotic mass) in reconstruction of the condyle after gap arthroplasty for ankylosis of the temporomandibular joint (TMJ). Sixteen patients (23 joints) operated on between 2007 and 2009 were studied and postoperative measurements of maximum interincisal opening, bite force, range of movement, and infection were recorded. After a mean (SD) follow up of 55 (2.25) months mouth opening improved from 3 (3.84) mm to 33 (1.66) mm in patients treated with coronoid graft, while in patients treated with an ankylotic mass after a mean (SD) follow up of 58 (1.58) months it increased from 4 (2.64) mm to 26 (8.04) mm. Bite force six months postoperatively ranged from 18.25kg/cm2 – 27.5kg/cm2 after reconstruction with the coronoid process and 18.5kg/cm2 – 23.25kg/cm2 after reconstruction with the ankylotic mass. One patient developed reankylosis postoperatively and another developed infection, in both of which the ankylotic mass had been used. Both were managed successfully. Both the ankylotic mass and the coronoid process gave satisfactory results and seem to be options for reconstruction. However, the coronoid process graft was better than residual ankylotic mass in terms of masticatory efficiency, bite force, and range of movement.

Comparison long-term effect of temporomandibular joint reconstruction with free coronoid process graft and costochondral graft in the treatment of temporomandibular joint ankylosis

Comparison long-term effect of temporomandibular joint reconstruction with free coronoid process graft and costochondral graft in the treatment of temporomandibular joint ankylosis

Retrospective comparison of autogenous cosotochondral graft and coronoid process graft in the management of unilateral ankylosis of the temporomandibular joint in adults

We retrospectively compared the clinical outcomes of autogenous coronoid process grafts (n=32) and costochondral grafts (n=28) in condylar reconstruction for the treatment of unilateral ankylosis of the temporomandibular joint (TMJ) in adults. Preoperative and postoperative assessments included diet scores, cone-beam computed tomography (CT), maximal interincisal opening, lateral excursion, and mandibular deviation on opening the mouth. There were no significant differences between the 2 groups in the measurements before and after the operation with respect to incisal opening, lateral excursion, mandibular deviation, diet scores, or recurrence rate, but in both the postoperative incisal opening, lateral excursion, and diet scores had improved significantly compared with preoperatively. After costochondral graft 3 patients developed intraoperative plural tears, and 6 had temporary pain at the donor site. The frontal branch of the facial nerve was temporarily affected in 5 patients after costochondral graft and 3 after coronoid process grafts, all of which recovered in 3–6 months. There was no recurrence after coronoid process grafting, and one after costochondral grafting. The clinical outcomes in both groups were satisfactory and comparable. Autogenous coronoid process grafting may therefore be a good alternative for condylar reconstruction in patients with ankylosis of the TMJ.

Particulated coronoid process grafts in marginal mandibulectomy

Particulated coronoid process grafts in marginal mandibulectomy

Applications of Coronoid Process as a Bone Graft in Maxillofacial Surgery

The coronoid process can be easily harvested as a donor bone by an intraoral approach during many maxillofacial surgery procedures. The purpose of this study was to evaluate the utility of autogenous coronoid process bone grafts for maxillofacial reconstructive surgery. Twelve patients, who underwent coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or temporomandibular joint ankylosis, were included in the study. There were 3 orbital defects after extended maxillectomy, 1 blowout fracture of the orbit, 2 cases of reconstruction after temporomandibular joint ankylosis surgery, 1 case of additional chin augmentation following horizontal flip genioplasty, 1 defect of anterior wall of maxilla due to trauma, 2 mandibular defects, and 2 cases of bone augmentation for implants.We recommend the use of coronoid process of the mandible as a source for autogenous bone graft as it can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.

Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible condylar in patients with temporomandibular joint ankylosis

The aim of this study was to investigate the feasibility of autogenous coronoid process pedicled on temporal muscle grafts (ACPTMG) for reconstruction of the mandible condyle, and to compare the differences in clinical effects with autogenous free coronoid process grafts (AFCPG) in patients with temporomandibular joint (TMJ) ankylosis. From 2003 to 2005, 48 patients who were diagnosed with uni- or bilateral TMJ ankylosis were randomly divided into 2 groups: group A(24 cases, 28 joints) and group B(24 cases, 30 joints). All patients underwent operations for resection of condyle and surrounding bony masses and simultaneous recreation of the glenoid fossa, which was followed with, for group A, condylar reconstruction using ACPTMG and, for group B, AFCPG, as well as interposition of temporal muscle myofascial flaps or native articular disc. The pre- and postoperative interinsicial opening values and mouth-opening deviation were measured, and decrease in height of mandible ramus was analyzed by panoramic radiographs. All patients showed apparent improved joint function except 1 patient of group B, who showed signs of reankylosis of the joint (<20 mm mouth opening). Radiographic examination and 3-dimensional computerized tomography both showed the grafts to be well attached to the ramus in their original positions and adaptive remodeling in both groups, but relatively more evident bony resorption was noted in group B. The mean measurement of mouth-opening deviation and postoperative decrease in height of mandible ramus in group B were significantly higher than in group A. Satisfactory clinical outcomes show that both ACPTMG and AFCPG seem to be alternative and promising methods in the treatment of TMJ bony ankylosis. Compared with AFCPG, the advantages of ACPTMG include less bony resorption and better long-term clinical outcomes.

Autogenous coronoid process grafts for condylar reconstruction in temporomandibular joint ankylosis

Background and Objectives: Temporomandibular joint (TMJ) ankylosis is a formidable problem in oral and maxillofacial surgery. The coronoid process often needs to be resected and discharged in the patients with TMJ ankylosis. This study describes the use the coronoid process as a candidate material for condylar reconstruction in the patients with TMJ ankylosis.

A New Distraction Treatment for Bilateral Mandibular Condylar Fractures: Application of a Dynamic Internal Distraction Device

ackground and Objectives: The aim f this study is to report the Egyptian xperience in the management of temporoandibular joint (TMJ) ankylosis at Tanta niversity, and to discuss the outcomes nd complications of different surgical odalities employed in the Department of ral and Maxillofacial Surgery, during the eriod 1995 to 2006. ethods: One hundred and one patients 109 joints), who met the inclusion crieria were reviewed in this retrospective tudy. The preand postoperative assessent included a detailed patient history, adiological and physical examination, egree of deformity and mouth openng. Data concerning age, sex, aetiology, oint(s) affected, different surgical modalties, complications and follow-up periods ere evaluated. esults: Various stages of TMJ ankylosis fibrous, bony or mixed) were diagnosed; he trauma was found to be the most requent aetiological factor. The age of he patients’ ranged from 2 to 41 years mean 19.4 years), 62.4% of them were emales, and were followed up for 14–96 onths (mean 28.9 months). The average outh opening was significantly increased rom 5.3 mm preoperatively to 32.5 mm months postoperatively (P= 0.000). arked improvement was documented hen the ramus-joint complex was recontructed using distraction osteogenesis lus interposition temporomyofascial flap TMF; 35.1 mm); costochondral graft plus MF (33.5 mm) or buccal pad fat flap 34.6 mm); coronoid process graft plus MF (34.4 mm); and Surgibone (35.1 mm) P= 0.001]. Operative and postoperative omplications (33.3%) included transient acial palsy (11.0%); bleeding (5.6%); nfection (4.6%); and reankylosis (4.6%). onclusion: It can be concluded that early elease of the TMJ ankylosis, reconstrucion of the ramus height with DO or one graft, separation of the articulating are bone with interpositional autologous aps followed by postoperative vigorous hysiotherapy was found to be the best line of treatment for management of TMJ ankylosis.

Free grafting of autogenous coronoid process for condylar reconstruction in patients with temporomandibular joint ankylosis

This article describes the clinical effects of condylar reconstruction by free grafting of autogenous coronoid process in patients with temporomandibular joint (TMJ) ankylosis. Fifteen cases of uni- or bilateral TMJ ankylosis during a 3-year period from March 2004 to March 2007 were surgically treated, and the average observation period was 22 months. All patients were treated by condylar reconstruction of immediate autogenous coronoid process grafts. Temporal muscle myofascial flaps or native articular disc was used as an interpositional tissue. Clinical examination, radiographs, and photographs were used postoperatively to evaluate the grafts and TMJ function. Satisfactory mouth opening was achieved in 14 cases, and 1 patient showed signs of reankylosis of the joint (20 mm mouth opening). Radiographic examination showed that bone union occurred between the grafts and the ramus in all cases. Some bony resorption of the grafted coronoid process was observed in all patients, but no occlusal changes were noted. Satisfactory clinical outcomes are obtained after the condylar reconstruction by free grafting of autogenous coronoid process. Therefore, autogenous coronoid process may be a suitable bone resource for condylar reconstruction in patients with TMJ ankylosis.

Autogenous coronoid process as a new donor source for reconstruction of mandibular condyle: An experimental study on goats

To evaluate the feasibility and effectiveness of autogenous coronoid process grafts for reconstruction of the mandibular condyle. Two groups of 9 goats each were used. Each animal underwent unilateral total condyle and disk removal and was treated by grafting an autogeneous coronoid process. The animals in group A were sacrificed at 4, 12, and 24 weeks after surgical procedure, and their grafted coronoid processes were harvested for histological observation. All animals in group B received 3-dimensional CT scanning examination at different times and were sacrificed at 24 weeks after surgical procedure. The items of ramus height (RH), transverse dimension of the condyle (CT), and posteroanterior dimension of the condyle (CP) were measured for comparison with the operated and nonoperated sides. Despite the differences in the measurements of RH, CT, and CP between the operated and nonoperated sides, the grafted coronoid process had a similar shape and histological structures to the normal condyle at 24 weeks after surgical procedure. The head of the neocondyle was covered by a cap of fibrous tissue, which might play the role of the articular disc. Under the mechanical stimuli of the temporomandibular joint site, the grafted coronoid process could gradually remodel to a neocondyle with functional shape and structure in goats. This animal study suggests that autogenous coronoid process could be considered as a new donor source for reconstruction of the mandibular condyle.

Modified coronoid process grafts combined with sagittal split osteotomy for treatment of bilateral temporomandibular joint ankylosis

Purpose: This article describes the use of autogenous coronoid process grafts for lengthening the ramus in patients with long-standing temporomandibular joint (TMJ) ankylosis and severe mandibular retrognathia. Patients and methods: A retrospective clinical study of 6 cases of bilateral TMJ ankylosis surgically treated during a 3-year period from June 1996 to March 1999 was performed. All patients were treated by condylectomy, mandibular sagittal split osteotomy, and immediate autogenous coroniod process grafts. Clinical examination, radiographs, and photographs were used postsurgically to evaluate the grafts, condylar function, and facial appearance. Results: Very satisfactory postsurgical results were obtained in terms of function of the TMJ, the airway, and aesthetics. Conclusion: In children suffering from TMJ ankylosis, the coronoid process can be used for mandibular lengthening. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:11-18, 2002