Preserved costal cartilage homograft application for the treatment of temporomandibular joint ankylosis

Ankylosis of the temporomandibular joint has been a daunting problem in ora l and maxillofacial surgery. Condylectomy with gap arthroplasty is the basi c technique for treatment of the fully grown patient. In the past, reconstr uction has primarily been accomplished with alloplastic materials or with a utogenous tissue harvested from the patient. Joints reconstructed with allo plastic materials have been subject to complications such as acute infectio n and chronic inflammatory problems as a result of foreign-body reaction wi th the immune system. Biologic reconstruction with autogenous materials doe s expose the patient to the risk of complications at the donor site. In the last 4 years, we have treated seven patients between the ages of 20 and 42 years who had complete temporomandibular joint ankylosis. In each patient, the affected joint was exposed through an extended preauricular incision. The ankylosed mandibular condyle with the surrounding abnormal bone, togeth er with the coronoid process, was resected and removed. The ankylosed area was resected until an improvement of at least 15 mm in the interincisal ope ning distance was obtained. A solvent-preserved homologous cartilage graft was sculpted according to the size and shape of the gap and was then placed in it as interpositional material. Physical therapy, including active and passive mouth-opening exercises, began on the second postoperative day and continued for 6 months. Patients were observed for 6 months to 4 years. Dur ing this period, no major complications were noted, and satisfactory result s were obtained. The initial mean interincisal opening distance was 15.2 mm after surgery, and the final mean interincisal opening distance was 32 mm after completion of physiotherapy. No recurrence was seen during the 4 year s of follow-up. This technique seems to be an effective, time-saving, and s imple alternative to other methods of joint reconstruction in adults who ha ve fairly extensive ankylosis of the temporomandibular joint. In this artic le, a description of the surgical technique, a review of all cases, and rec ommendations for the use of this type of graft material are discussed. Our clinical experience over the past 4 years with the use of preserved homolog ous costal cartilage grafts as interpositional material has been encouragin g.