Department of Oral and Maxillofacial Surgery, Infanta Cristina University Hospital, Badajoz, Spain.
Med Oral Patol Oral Cir Bucal. 2009 Dec 1;14(12):e663-7. doi: 10.4317/medoral.14.e663.
Since its publication in 1920 by Gillies, costochondral grafts have been used by surgeons to replace and injured mandibular condyle and to reconstruct the temporomandibular joint. This procedure is currently applied in cases of congenital dysplasia, developmental defects, temporomandibular ankylosis, neoplastic disease, osteoarthritis and post-traumatic dysfunction. Over the years, various procedures for the reconstruction with this type of graft have been described. In 1989, Mosby and Hiatt described a technique for setting the graft securely, reducing the space between the graft and the mandibular area. In 1998, Monje and Martín-Granizo developed a variation of this method, enabling a precise adaptation of the costochondral graft to the remaining mandibular ramus. The aim of this study is to evaluate the functional and anatomic results of the costochondral graft treatment by green-stick fracture for reconstruction of the TMJ in the 10 years following the description of this technique. We carry out a retrospective study of thirteen cases of temporomandibular pathology (tumors, ankylosis and hypoplasia) treated during a period of ten years from 1998 to 2008. In all these cases, the technique described by Monje and Martín-Granizo was used: removal of the sixth rib, fixation to a titanium mini-plate using screws, making an internal corticotomy in order to obtain a green-stick fracture of the outer cortex, providing adequate adaptation of the graft to the mandibular ramus. The graft was then set in place, attaching it with titanium screws. This technique was successful in achieving optimal ossification, a good interincisal opening and satisfactory cosmetic results. In conclusion, according to our experience, the green-stick fracture for the adaptation of costochondral grafts to the remaining mandibular ramus has presented outstanding results in the surgical treatment of temporomandibular pathology.
自吉列斯（Gillies）于 1920 年发表以来，肋软骨移植已被外科医生用于替代受损的下颌骨髁突并重建颞下颌关节。该手术目前应用于先天性发育不良、发育缺陷、颞下颌关节强直、肿瘤疾病、骨关节炎和创伤后功能障碍。多年来，已经描述了使用这种移植物进行重建的各种手术方法。1989 年，莫斯比（Mosby）和海厄特（Hiatt）描述了一种将移植物固定的技术，减少了移植物和下颌区域之间的空间。1998 年，蒙赫（Monje）和马丁-格拉尼索（Martín-Granizo）对该方法进行了改进，使肋软骨移植物能够精确适应下颌骨的剩余支。本研究的目的是评估在该技术描述后的 10 年内，通过青枝骨折重建 TMJ 治疗的肋软骨移植物的功能和解剖学结果。我们对 1998 年至 2008 年期间 10 年间治疗的 13 例颞下颌病理学（肿瘤、强直和发育不良）病例进行了回顾性研究。在所有这些病例中，均使用了蒙赫（Monje）和马丁-格拉尼索（Martín-Granizo）描述的技术：切除第 6 肋，用螺钉固定在钛微型板上，进行内部皮质切开术以获得外皮质的青枝骨折，使移植物与下颌骨支充分适应，然后将移植物放入适当位置，用钛螺钉固定。该技术成功地实现了最佳的骨化、良好的切牙开口和满意的美容效果。总之，根据我们的经验，对于适应肋软骨移植物到剩余下颌骨支的青枝骨折，在颞下颌病理学的手术治疗中取得了出色的效果。
