Use of activator appliances in pediatric patients treated with costochondral grafts for temporomandibular joint ankylosis: analysis of 13 cases.
OBJECTIVE
The long-term outcomes and clinical results of costochondral transplants used for the treatment of condylar ankylosis of the mandible in children with and without application of postoperative activator appliances are evaluated and compared.


METHODS
A nonrandomized, retrospective clinical study of 13 cases of condylar ankylosis (16 joints) of the mandible surgically treated during a 9-year period from 1988 to 1997 was performed. All 13 patients were treated by condylectomy and immediate costochondral rib grafts. Nine of these patients underwent long-term postoperative therapy using removable activator appliances. Four patients did not undergo activator therapy postoperatively. Casts, radiographs, photographs, computed tomography (CT) scans, magnetic resonance imaging (MRI) and 99Tc bone scans were used postsurgically to evaluate graft take, condylar growth and function, occlusion, and facial and condylar symmetry.


RESULTS
The postoperative and long-term clinical results in both groups showed costochondral growth center transplants to be effective in restoring mandibular growth of the affected side. However, symmetry, arch coordination, correction of occlusal canting, mandibular deviation, facial growth, and prevention of reankylosis were obtained and better controlled only in those cases that underwent long-term orthodontic activator therapy postoperatively and were followed closely.


CONCLUSIONS
Children with long-standing condylar ankylosis of the mandible and its resultant facial asymmetry and occlusal canting (secondary to a nonfunctional joint and maxillary compensation) treated with condylectomy and immediate costochondral rib graft reconstruction of the affected joint were treated more favorably when activators were used postsurgically. The patients that failed to comply with or continue activator therapy postsurgically developed complications relating to mandibular deviation, occlusal dysharmony, asymmetry and, in one case, reankylosis of the temporomandibular joint (TMJ).
Behnia
H
H
Department of Oral and Maxillofacial Surgery, Taleghani Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
Motamedi
M H
MH
Tehranchi
A
A
D000202:Activator Appliances; D000293:Adolescent; D000844:Ankylosis / Q000473:pathology / Q000601:surgery*; D016025:Bone Transplantation / Q000473:pathology; D002356:Cartilage / Q000473:pathology / Q000637:transplantation*; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005146:Facial Asymmetry / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008310:Malocclusion / Q000601:surgery; D008335:Mandibular Condyle / Q000254:growth & development / Q000503:physiopathology / Q000601:surgery; D008336:Mandibular Diseases / Q000601:surgery; D008445:Maxillofacial Development; D003765:Models, Dental; D010027:Osteotomy; D010781:Photography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013667:Technetium; D013705:Temporomandibular Joint Disorders / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D013667:Technetium