Awal D H, Jaffer M, Charan G, Ball R E, Kennedy G, Thomas S, Farook S A, Mills C, Ayliffe P
Department of Maxillofacial Surgery, Great Ormond Street Hospital for Children, London, UK.
Department of Maxillofacial Surgery, Great Ormond Street Hospital for Children, London, UK.
Int J Oral Maxillofac Surg. 2018 Nov;47(11):1433-1438. doi: 10.1016/j.ijom.2018.06.004. Epub 2018 Jun 28.
Costochondral grafting (CCG) can be used for the reconstruction of ankylotic, hypoplastic, and resected temporomandibular joint (TMJ) defects. CCGs have previously been considered the gold standard in children due to their growth potential and autogenous origin, but the disadvantages are unpredictable growth and joint ankylosis. This was a retrospective study of all children who received CCGs for TMJ reconstruction from 1985 to 2004, to allow a 10-year follow-up. Fifty-five patients were included in this study, with 74 grafts being placed; their mean age was 7.9±4.2years. Infection-related ankylosis (18.2%) and craniofacial microsomia (16.4%) were the most common diagnoses. Overall, 58.2% of patients suffered one or more complications over the follow-up period, with ankylosis (32.7%) and overgrowth (16.4%) being most common. There was a significant correlation between those with infection-related ankylosis and subsequent complications (χ=8.8, df=1, P<0.005), while ankylotic patients in general exhibited greater overall complication rates (χ=9.0, df=1, P<0.005). Patients with congenital TMJ defects were more likely to be complication-free than those with acquired defects (χ=4.0, df=1, P<0.05). Caution is advised when placing CCGs in paediatric patients with ankylosed TMJs, especially those with infection-related ankylosis.
肋软骨移植（CCG）可用于重建强直性、发育不全性和切除后的颞下颌关节（TMJ）缺损。由于其生长潜力和自体来源，CCG以前被认为是儿童治疗的金标准，但缺点是生长不可预测和关节强直。这是一项对1985年至2004年期间接受CCG进行TMJ重建的所有儿童的回顾性研究，以便进行10年的随访。本研究纳入了55例患者，共植入74块移植骨；他们的平均年龄为7.9±4.2岁。感染相关性强直（18.2%）和颅面短小畸形（16.4%）是最常见的诊断。总体而言，58.2%的患者在随访期间出现了一种或多种并发症，其中强直（32.7%）和过度生长（16.4%）最为常见。感染相关性强直患者与随后的并发症之间存在显著相关性（χ=8.8，自由度=1，P<0.005），而一般强直患者的总体并发症发生率更高（χ=9.0，自由度=1，P<0.005）。先天性TMJ缺损患者比后天性缺损患者更不容易出现并发症（χ=4.0，自由度=1，P<0.05）。对于患有强直TMJ的儿科患者，尤其是那些感染相关性强直患者，在植入CCG时建议谨慎。
