USE OF ACTIVATOR APPLIANCES IN PEDIATRIC-PATIENTS TREATED WITH COSTOCHONDRAL GRAFTS FOR TEMPOROMANDIBULAR-JOINT ANKYLOSIS - ANALYSIS OF 13 CASES

Purpose: The long-term outcomes and clinical results of costochondral transplants used for the treatment of condylar ankylosis of the mandib le in children with and without application of postoperative activator appliances are evaluated and compared. Materials and Methods: A nonra ndomized, retrospective clinical study of 13 cases of condylar ankylos is (16 joints) of the mandible surgically treated during a 9-year peri od from 1988 to 1997 was performed. All 13 patients were treated by co ndylectomy and immediate costochondral rib grafts. Nine of these patie nts underwent long-term postoperative therapy using removable activato r appliances. Four patients did not undergo activator therapy postoper atively. Casts, radiographs, photographs, computed tomography (CT) sca ns, magnetic resonance imaging (MRI) and Tc-99 bone scans were used po stsurgically to evaluate graft take, condylar growth and function, occ lusion, and facial and condylar symmetry. Results-The postoperative an d long-term clinical results in both groups showed costochondral growt h center transplants to be effective in restoring mandibular growth of the affected side. However, symmetry, arch coordination, correction o f occlusal canting, mandibular deviation, facial growth, and preventio n of reankylosis were obtained and better controlled only in those cas es that underwent long-term orthodontic activator therapy postoperativ ely and were followed closely. Conclusions: Children with long-standin g condylar ankylosis of the mandible and its resultant facial asymmetr y and occlusal canting (secondary to a nonfunctional joint and maxilla ry compensation) treated with condylectomy and immediate costochondral rib graft reconstruction of the affected joint were treated more favo rably when activators were used postsurgically. The patients that fail ed to comply with or continue activator therapy postsurgically develop ed complications relating to mandibular deviation, occlusal dysharmony , asymmetry and, in one case, reankylosis of the temporomandibular joi nt (TMJ).