Viability of costochondral graft in temporomandibular joint ankylosis

ABSTRACT

Temporomandibular joint [TMJ] ankylosis is a very distressing structural condition that causes severe facial disfigurement leading to pathopsychological stress. Impairment of speech, difficulty with mastication, rampant caries, poor oral hygiene, disturbances of facial growth and severely compromised airway are the leading consequences of TMJ ankylosis. Surgical intervention is the widely accepted treatment modality of TMJ ankylosis. Current study was performed on 30 patients for three years [2009-2012] department of Oral and Maxillofacial Surgery, Children Hospital and Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore and costochondral graft was used to treat mandibular ankylosis. 21 [70%] patients were males and were divided into age groups of 2-5, 6-12 and 13-18 years. Regarding the side of mandible involved in male patients, unilateral ankylosis was found in 15[50%] and bilateral ankylosis were found in 6[20%] patients. Similarly in female patients, unilateral ankylosis was found in 7[23%] and bilateral ankylosis was seen in 2[7%] patients. Regarding post-operative monitoring of graft, bone scintigraphy was performed one week after the surgery and then after 12 weeks and 16 weeks to assess the viability and uptake of costochondral graft. Tc.99m MDP bone scan was performed in supine position with intravenous administration of 370MBq one week after the placement of graft. Results showed that out of 30 patients, CCG graft was viable in 28[93%] while it was non-viable in 2[7%] patients