The Use of Costochondral Graft In Paediatric Temporomandibular Joint Reconstruction – A Systematic Review And Meta-Analysis

Abstract

Abstract Background: Costochondral grafts (CCG) have been regarded as the gold standard for temporomandibular joint (TMJ) reconstruction in growing children and young adults, some authors oppose their use citing concerns about growth abnormalities of the graft. Our systematic review and meta-analysis aimed to assess surgical outcomes of using autogenous costochondral Graft (CCG) for TMJ reconstruction in paediatric and growing patients by assessing maximum interincisal opening (MIO), in addition to evaluating the preoperative aetiology of total TMJR and investigating post-operative complications and long-term success rates associated with total TMJR using CCGs in children and adolescents. Methods: A systematic review was conducted following PRISMA guidelines. The following databases were searched: Scopus, Web of Science, MEDLINE via OVID, and CENTRAL via Cochrane Library. Only randomised controlled trials and observational studies including paediatric and adolescent/young adult patients (age ≤ 18 years) with TMJ pathology, trauma, or congenital anomalies undergoing TMJ reconstruction utilising Costochondral Grafts were included. The outcomes evaluated were: Post-operative MIO and complications. Results: Ten studies satisfied all the inclusion criteria. A total number of 193 subjects and 234 grafts in 3 RCTs and 7 observational studies was included in this review. The most reported TMJ defect/preoperative aetiologies reported were Traumatic ankylosis (35%) followed by Infection-related ankylosis (17%) and congenital anomalies (17%). Following CCG reconstruction 55.44% of patients had optimal growth. A total of 44 % of patients had post-operative complications. The graft abnormalities reported were re-ankylosis (36%), undergrowth (26%), overgrowth (21%), and facial asymmetry (17%). Conclusion: The findings demonstrate the effectiveness of TMJ reconstruction using CCGs in improving the MIO in growing patients with acquired and congenerical TMJ deformities. However, our data also suggest that CCGs showed a considerable risk of postoperative complications. Notably, the grafts with medium-thickness cartilage were associated with the least incidence of long-term graft abnormalities.