Costochondral Grafting in Craniofacial Microsomia: Optimization of Results
Youssef Tahiri, MD, CM, MSc, FRCSC, FAAP1, Catherine Chang, MD 2, Jorien Tuin, MD2, Thomas J. Paliga, BA2, Jesse A. Taylor, MD2, Scott P. Bartlett, MD, FACS2.
1Indiana University, Indianapolis, IN, USA, 2Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Background: Costochondral rib grafting for mandibular reconstruction is notoriously challenging. We present the largest series of costochondral rib grafts for mandibular reconstruction in children with Pruzansky/Kaban Type 2B and 3 mandibular hypoplasia.
Methods: An IRB-approved prospectively maintained database of all patients with CFM who underwent rib grafting for mandibular reconstruction by the senior author from January 1998 to September 2013 was reviewed. Surgical and dental care is discussed in depth. Demographics, surgical history, operative details, plain radiographs, pre- and postoperative three-dimensional CT and photographs, postoperative complications, as well as outcomes were recorded.
Results: 255 patients were diagnosed with CFM. 33 costochondral rib grafts were performed; 11 unilateral and 11 bilateral reconstructions. 12 hemi-mandibles were type 2B and 21 were type 3. No intraoperative complications were reported, and no incidence of graft resorption was noted. No additional procedures were required in 27 reconstructed hemi-mandibles (81.8%), while six (18.2%) required secondary distraction osteogenesis (DO). The osteotomy for DO was performed at the level of the native mandible, mesial to the costochondral graft/mandible junction. The average distraction distance was 21.3 mm (±4.6 mm). The consolidation phase lasted on average 73 days (±11 days). DO was successful at correcting the mandibular asymmetry. None of the distracted patients required re-distraction to date. One patient developed postoperative ankylosis. No mal- or non-union was noted. One patient who was tracheostomy dependent was decannulated.
Conclusion: The approach described in this article allowed us to obtain reliably good results with rib grafting for Type 2B and 3 mandibular hypoplasia.
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