Mandibular condylar-ramal reconstruction using vascularised costochondral graft based on the serratus anterior composite flap

Abstract

Background: Nonvascularised autogenous costochondral rib grafts are the gold standard for replacement of the mandibular ramus and condyle. However, condylar defects present a difficult condition to treat when soft tissue defects are involved. Thus, we used vascularised costochondral grafts (VCGs) with a cartilaginous cap based on the serratus anterior muscle flap to reconstruct these composite defects. The purpose of this study was to evaluate the advantages and effectiveness of VCGs based on long-term observation. Methods: We evaluated 15 patients who underwent mandibular condyle and ramus reconstruction using VCG after a mean follow-up of 75.9 months (range 46-156 months). Our 15 case of mandibular reconstruction with a serratus anterior/rib composite free flap due to congenital or acquired defects involved a total of 18 condyles (bilateral reconstruction in 3 cases and unilateral reconstruction in 12 cases). Results: Our success rate with the use of the serratus anterior/rib composite free flap was 100%, and there were no cases of resorption or malunion of the graft. The mean maximum mouth opening (MMO) at the last follow-up was 31.29 +/- 7.56 mm (range 15-45 mm). Although two patients exhibited excessive growth of the graft, deficient growth of the graft was also found in our paediatric patients. Four patients who developed ankylosed TMJ during the follow-up period received additional gap arthroplasty. Conclusion: VCG based on a serratus anterior flap was an excellent treatment modality for patients with uni-or bilateral composite defects of the ramus and condyle, in which soft tissue and hard tissue, including both bone and cartilage, were necessary. (C) 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.