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Analysis of the effect on costochondral graft for TMJ ankylosis with jaw deformities in pediatrics

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Abstract

Objectives

To evaluate the effects of costochondral grafting (CCG) used for temporomandibular joint ankylosis (TMJA) in growing patients.

Materials and methods

Pediatric patients with TMJA treated by CCG from 2010.5 to 2021.7 were included in the study. CT scans were performed before and after operations with at least 1 year follow-up. The height of the mandibular ramus, menton deviation or retraction, osteotomy gap, etc. were measured by ProPlan CMF1.4 software. CCG growth, resorption, and relapse were evaluated and analyzed with influencing factors such as age, ostectomy gap, etc. by generalized estimating equation.

Results

There were 24 patients (29 joints) with an average age of 6.30 ± 3.13 years in the study. After operation, the mandibular ramus was elongated by 5.97 ± 3.53 mm. Mandibular deviation or retrusion was corrected by 4.82 ± 2.84 mm and 3.76 ± 2.97 mm respectively. After a mean follow-up of 38.91 ± 29.20 months, 58.62% CCG grew (4.18 ± 7.70 mm), 20.69% absorbed (2.23 ± 1.16 mm), and 20.69% re-ankylosed. The re-ankylosis was negatively correlated with the osteotomy gap (OR:0.348,0.172–0.702 95%CI, critical value = 6.10 mm). CCG resorption was positively correlated with the distance of CCG ramus elongation (OR:3.353,1.173–9.586 95%CI, critical value = 7.40 mm).

Conclusions

An adequate osteotomy gap and CCG ramus elongation distance are the key factors for successful treatment of TMJA with jaw deformities in growing patients.

Clinical relevance

TMJA affects mouth opening and jaw development in pediatric patients. The most common autogenous bone graft for pediatric patients is CCG due to its growth potential, convenient access and easy contouring. Also, it can simultaneously reconstruct the TMJ and improve jaw deformity by lengthening the mandibular ramus. But the growth of CCG is unpredictable. In this study, we explored several factors that may affect the absorption and re-ankylosis of CCG, expecting to provide several suggestions to improve future CCG treatment.

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Data availability

No datasets were generated or analysed during the current study.

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Funding

This study was supported by grants from the National Natural Science Foundation of China (32071313, 82270996); Cross-disciplinary Research Fund, Rare diseases registration project, Fund of Department of Oral and Maxillofacial Surgery of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (JYJC202203, JYHJB202304, 2023-03), Shanghai’s Top Priority Research Center (2022ZZ01017), CAMS Innovation Fund for Medical Sciences (CIFMS, 2019-I2M-5-037).

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Author notes

  1. Xiaoli Zhang and Dong Huang co-first authors.

Authors and Affiliations

  1. Department of Oral Surgery, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai, 200011, China

    Xiaoli Zhang, Dong Huang, Chuan Lu, Jieyun Zhao, Chi Yang & Dongmei He

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  1. Xiaoli Zhang
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  2. Dong Huang
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  3. Chuan Lu
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  4. Jieyun Zhao
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  5. Chi Yang
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  6. Dongmei He
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Contributions

XL.Z: data curation, formal analysis, validation, writing the main manuscript text. D.H: methodology, investigation, writing the main manuscript text. C.L: prepared Figs. 1, 2 and 3. JY.Z: prepared Figs. 4, 5 and 6. DM.H and C.Y: conceptualization, resources, supervision, reviewing and editing the manuscript.

XL.Z and D.H contributed equally to this work.

Corresponding authors

Correspondence to Chi Yang or Dongmei He.

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Ethics approval and consent to participate

This study was approved by the ethics committee and institutional review board of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (No. SH9H-2023-T368-1). The patient provided written informed consent for publishing of this case report and accompanying photographs. The written consent is available on request.

Competing interests

The authors declare no competing interests.

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The authors declare that they have no financial or personal interests related to the present work.

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Zhang, X., Huang, D., Lu, C. et al. Analysis of the effect on costochondral graft for TMJ ankylosis with jaw deformities in pediatrics. Clin Oral Invest 28, 317 (2024). https://doi.org/10.1007/s00784-024-05708-0

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