COSTOCHONDRAL GRAFTS TO REPLACE MANDIBULAR CONDYLES IN JUVENILE CHRONIC ARTHRITIS PATIENTS - LONG-TERM EFFECTS ON FACIAL GROWTH

Long-term facial growth and clinical outcome after replacement of arth ritic mandibular condyles by costochondral grafts and postoperative or thodontic guidance of the occlusion were studied until completion of f acial growth in patients (n=12) with juvenile chronic arthritis (JCA) affecting their temporo-mandibular joints (TMJs). The patients were be tween 10.1 and 16.7 years of age at surgery. Clinical records and radi ographs far cephalometric measurements were taken preoperatively, 6-8 weeks after surgery and after completion of facial growth. A considera ble potential for growth of the costochondral graft/mandible unit was demonstrated in all patients. The results also indicated a considerabl e risk of asymmetrical mandibular overgrowth (n=8), which could not be correctly assessed until after skeletal maturation was complete. With out any active orthodontic treatment, compensatory growth of the alveo lar processes closed the lateral open bites, which were created during surgery. The functional results of the reconstructed temporo-mandibul ar joints were good and the morbidity rate was low. Costochondral graf ting is a versatile treatment when the TMJs are severely affected by J CA, but requires supervision of patients until skeletal maturation, to monitor possible mandibular overgrowth. Advantages of this method wer e re-established mandibular growth, good mandibular function, a low mo rbidity rate and early aesthetic improvement.