Abstract
Mandibular reconstruction in patients with hemifacial microsomia is still challenging.
In this study we have introduced a costochondral graft (CCG) for reconstruction of
the mandibular ramus, and reported a bone-supported osteotomy and repositioning guide
system for transfer of a virtual plan. Fourteen young children with Pruzansky type
III hemifacial microsomia were included and treated with CCG to reconstruct the ramus.
We first made 3-dimensional models for virtual planning and simulation, with calculations
for both the position and direction of the CCG, to achieve optimal morphology. We
did an osteotomy and manufactured them using a 3-dimensional printing technique. Accuracy
was evaluated by comparing the plan with the postoperative outcomes. The largest linear
root-mean-square deviation (RMSD) between the planned and the postoperative CCG was
4.41 mm in the anteroposterior direction, while the largest angle RMSD was 19.25° in the
horizontal plane. We suggest that the accuracy of this new custom-made guide system
is clinically acceptable for transferring the position and direction of the CCG.
Keywords
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References
- Not all dwarfed mandibles are alike.Birth Defects. 1969; 5: 120-129
- Analysis and treatment of hemifacial microsomia in childhood.Clin Plast Surg. 1987; 14: 91-100
- Costochondral grafts replacing the mandibular condyle.Cleft Palate Craniofac J. 1999; 36: 334-339
- Midfacial growth after costochondral graft construction of the mandibular ramus in hemifacial microsomia.J Oral Maxillofac Surg. 1998; 56: 122-128
- Rib reconstruction of the absent mandibular condyle in children.Otolaryngol Head Neck Surg. 2013; 149: 372-376
- Costochondral graft construction/reconstruction of the ramus/condyle unit: long-term follow-up.Int J Oral Maxillofac Surg. 1994; 23: 321-328
- Long-term follow-up of a mandibular costochondral graft.Oral Surg Oral Med Oral Pathol. 1984; 58: 257-268
- Costochondral graft in young children with hemifacial microsomia.J Craniofac Surg. 2017; 28: 129-133
- Three-dimensional planning and printing of guides and templates for reconstruction of the mandibular ramus and condyle using autogenous costochondral grafts.Br J Oral Maxillofac Surg. 2017; 55: 102-104
- Accuracy of a computer-aided surgical simulation protocol for orthognathic surgery: a prospective multicenter study.J Oral Maxillofac Surg. 2013; 71: 128-142
- Accuracy of a cad/cam surgical template for mandibular distraction: A preliminary study.Br J Oral Maxillofac Surg. 2018; 56: 814-819
- Thorne C.H. Beasley R.W. Aston S.J. Grabb & Smith’s plastic surgery. 6th (revised) ed. Lippincott Williams & Wilkins, Philadelphia1997
- Unpredictable growth pattern of costochondral graft.Plast Reconstr Surg. 1992; 90: 880-889
- Distraction osteogenesis of costocartilaginous rib grafts and treatment algorithm for severely hypoplastic mandibles.Plast Reconstr Surg. 2011; 127: 2005-2013
- Costochondral grafting in craniofacial microsomia.Plast Reconstr Surg. 2015; 135: 530-541
- Histology of surgically removed overgrown osteochondral rib grafts.J Craniomaxillofac Surg. 2002; 30: 355-360
Article info
Publication history
Published online: October 17, 2019
Accepted:
September 29,
2019
Identification
Copyright
© 2019 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.
