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Mao Y, Chen X, Yu S, Xu W, Qin H, Zhen J, Qiu Y, Zhang S, Yang C. Biomechanical analysis of costochondral graft fracture in temporomandibular joint replacement. Sci Rep 2020; 10:17754. [PMID: 33082437 PMCID: PMC7576606 DOI: 10.1038/s41598-020-74548-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 10/05/2020] [Indexed: 12/03/2022] Open
Abstract
This study is the first attempt to explore the reason of costochondral graft fracture after lengthy mandible advancement and bilateral coronoidectomy by combining finite element analysis and mechanical test. Eleven groups of models were established to simulate costochondral graft reconstruction in different degrees of mandible advancement, ranging from 0 to 20 mm, in 2 mm increment. Force and stress distribution in the rib-cartilage area were analyzed by finite element analysis. Mechanical test was used to evaluate the resistance of the rib-cartilage complex. Results showed a sharp increase in horizontal force between 8 and 10 mm mandible advancement, from 26.7 to 196.7 N in the left side, and continue increased after 10 mm, which was beyond bone-cartilage junction resistance according to mechanical test. Therefore, we concluded that bilateral reconstruction with coronoidectomy for lengthy mandible advancement (≥ 10 mm) may lead to prominent increase in shear force and result in a costal-cartilage junction fracture, in this situation, alloplastic prosthesis could be a better choice. We also suggested that coronoidectomy should be carefully considered unless necessary.
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Affiliation(s)
- Yi Mao
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Xuzhuo Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Shiqi Yu
- Shanghai Ninth People's Hospital, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Weifeng Xu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Haiyi Qin
- National Die and Mold CAD Engineering Research Center, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Jinze Zhen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
| | - Yating Qiu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
| | - Shanyong Zhang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
| | - Chi Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, 200011, China
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Awal D, Jaffer M, Charan G, Ball R, Kennedy G, Thomas S, Farook S, Mills C, Ayliffe P. Costochondral grafting for paediatric temporomandibular joint reconstruction: 10-year outcomes in 55 cases. Int J Oral Maxillofac Surg 2018; 47:1433-1438. [DOI: 10.1016/j.ijom.2018.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/04/2018] [Accepted: 06/13/2018] [Indexed: 11/28/2022]
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Efficacy of Standard Costochondral Grafting in Patients With Bilateral Craniofacial Microsomia. J Craniofac Surg 2016; 27:e673-e676. [PMID: 27617809 DOI: 10.1097/scs.0000000000003075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Craniofacial microsomia remains the second most common craniofacial deformity after cleft lip and palate. Mandibular pathology has been classically scored from type I to type III by the modified Pruzansky-Kaban classification. The authors report a case of a 5-year-old patient with Goldenhar syndrome and bilateral type III craniofacial macrosomia. The patient had absence of bilateral glenoid fossas, condyles, coronoids, and rami as well as hypoplasia of the symphysis, parasymphysis, and mandibular body. Reconstruction was performed using 2 costochondral rib autografts to reconstruct a ramus and assist in the development of a neo-glenoid fossa at the cranial base. An additional portion of costal rib graft was used to augment the deficient symphysis. The patient was placed in class III occlusion postoperatively using maxillo-mandibular fixation screws and heavy elastics. The bone grafts healed without complications with no evidence of ankylosis, nonunion, or resorption to date. For the most severe forms of craniofacial microsomia, costochondral grafting remains an effective initial technique for lengthening the hypoplastic mandible and providing a foundation for future distraction.
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