Clinical and retrospective study of costochondral rib grafting

늑연골 이식술은 수년동안 오랜 경험으로 종양수술 후 하악과두 재건, 선천적 발생학적 기형의 교정, 강직중의 치료, 외상 후 재건 및 관절염시 관절 대체물로 사용되어져 왔다. 저자들은 하악과두 재건술을 위한 늑연골 이식의 임상적 소급적 분석을 토대로 그 예후에 대해 관찰하였다. 본 임상연구는 종양 절제술, 외상 또는 악관절 강직중 수술 등의 원인으로 발생된 하악과두 결손부를 자가 늑연골 이식술을 시행한 10명의 환자에서 수술 후 장기간 관찰하여 악운동 기능, 안모개선, 저작기능 및 추적조사 기간중의 하악골 성장 등에 대하여 연구, 조사하여 다소의 흥미있는 결과를 얻었다. 성인의 경우 하악과두 결손부의 재건을 시행한 4례에서는 기능적 심미적으로 양호한 결과를 얻었다. 성장중인 환자 6례에 있어서 3례는 다소 하악골 저성장을 보이고, 2례는 정상적인 하악골 성장이 관찰되었고, 1례의 경우 극심한 과성장이 초래되어 2차로 과두 절제술 및 악교정 수술을 시행한 바 있다. 결론적으로 성인에 있어 하악과두 결손을 재건하기 위해 늑연골 이식술이 추천 되어지나 성장중인 환자의 경우 수술후 하악골 성장을 예견하기 어렵기 때문에 신중히 고려되어야 할 것으로 사료되어 진다.

Costochondral grafts had been used empirically for many years in the following ablative tumor surgery, correction of congenital and developmental deformities, treatment of ankylosis of joint. Anatomical or functional loss of the mandiblar condyle and eventually the ascending ramus and glenoid fossa, may be caused by trauma, infection, congenital dysplasia or surgery. Reconstruction of the temporomandibular joint (TMJ) is a challenging and sometimes frustrating aspect of oral and maxillofacial surgery. Over time, several techniques have used a variety of materials, both alloplastic and autogenous. The use of costochondral grafts for reconstruction of the TMJ was first described by Gillies in 1920. Since that time, costochondral grafting has proven to be a versatile procedure with a high rate of success. The treatment of the lost condyle must include the following requirements : 1. Restoration of vertical, protrusive and lateral movements of the mandible, to re-estabilish adequate mouth opening. 2. Restoration and maintenance of the vertical dimension, improvement of the dental occlusion and avoidance of postoperative apertognathia. 3. Restoration of facial symmetry, at rest and on movement, during and after cessation of growth. 4. Avoidance of recurrent ankylosis. This paper reports the surgical and functional reults of the restrospective analysis of costochondral grafting. This clinical study was achieved to interesting results about mandibular movement, masticatory function, improvement of facial disfigurement and mandibular growth through long term follow-up in condylar reconstruction with autogenous costochondral graft for 10 patients who had undergone tumor, trauma, and TMJ ankylosis surgery. Condylar reconstruction with costochondral graft for yields satisfactory cosmetic and functional results in 4 adult patients. The long term follow-up of 6 patients yields who had undergone costochondral grafting in the growing period was done. Three of the six patients yields more or less mandibular undergrowth. Two of the six patients developed normal mandibular growth. One of the these patients performed secondary condylectomy and orthognathic surgery because of severe mandibular overgrowth. Conclusionally, condylar reconstruction with costochondral graft is recommended in adult, but must significantly consider due to unpredictable post-operative mandibular growth in growing child.