The use of costochondral grafts in arthroplasty of the temporomandibular joint

A potential role for costo-chondral grafting in adults with mandibular condylar destruction secondary to rheumatoid arthritis--a case report

Little attention has been directed towards reconstruction of the mandibular condyles in adult patients with rheumatoid arthritis, other than with allogenic implants which are now known to cause serious complications. There is a relatively high incidence of condylar erosion and breakdown in rheumatoid arthritis, often leading to anterior open bite and retrognathia. Costochondral grafting does not appear to have been considered as a logical option for reconstruction, despite its high success rate in many other situations. A case is described of rapid bilateral condylar destruction occurring in a young woman with rheumatoid arthritis, leading to anterior open bite. Reconstruction was undertaken using bilateral costochondral grafts, giving an excellent clinical result which has been maintained over the follow-up period of two-and-a-half years. Radiologically complete healing of severe glenoid fossa erosion has taken place.

Growth of a costochondral graft in the rat temporomandibular joint

The aim of this study was to examine the growth and adaptation of costochondral grafts in the temporomandibular joint (TMJ). An autogenous rib section with either a short, intermediate, or long cartilaginous end was transplanted to replace the right mandibular condyle in 20-day-old rats. At 40 days, the mandibular halves with the short cartilage transplants were shorter than the contralateral halves, whereas the two sides did not differ in length in the rats with the intermediate transplant. The mandibular halves with the longest cartilaginous transplants initially were longer than the contralateral ones. The glenoid fossa was located more laterally as compared with the unoperated side. The results provide evidence that costochondral transplants do not adapt to the functional conditions of the TMJ and that the amount of cartilage in the graft has some bearing on its growth capacity.

Psoriatic arthropathy of the temporomandibular joint

A case of psoriatic arthritis of both temporomandibular joints is described with a brief review of the literature and discussion on the management of this condition. To date, psoriatic arthritis has been successfully treated by conservative means. In the case reported, surgical replacement of the condyles became necessary to eliminate pain and restore function.

Costochondral grafting for posttraumatic temporomandibular joint reconstruction: a review of six cases

Costochondral grafting in growing children for missing, diseased, or ankylosed condyles has been widely reported. The use of these grafts for temporomandibular joint (TMJ) reconstruction in nongrowing adults has received relatively little attention. This article reviews the use of costochondral grafts in six cases of posttraumatic TMJ dysfunction in adults. Four patients increased their maximum incisal opening by an average of 49.1%, and two patients showed decreases in opening. Overall clinical results were judged to be very good. It is emphasized that biologic reconstruction of the adult TMJ is preferable to alloplastic reconstruction because, just as in the growing child, the adult articulation must adapt to the demands of the functional matrix.

Reconstruction of the mandibular condyle using ramus osteotomies: a preliminary report

Reconstruction is required for a number of conditions in which condylar bone is lost resulting in dental and skeletal change. Ramus osteotomies are described as an alternative to the currently used methods. Four cases are described to illustrate the use of this technique. These osteotomies have several advantages over other methods and have the potential for better functional results.