Börje Svensson

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 arthritic mandibular condyles by costochondral grafts and postoperative orthodontic guidance of the occlusion were studied until completion of facial growth in patients (n = 12) with juvenile chronic arthritis (JCA) affecting their temporo-mandibular joints (TMJs). The patients were between 10.1 and 16.7 years of age at surgery. Clinical records and radiographs for cephalometric measurements were taken preoperatively, 6-8 weeks after surgery and after completion of facial growth. A considerable potential for growth of the costochondral graft/mandible unit was demonstrated in all patients. The results also indicated a considerable risk of asymmetrical mandibular overgrowth (n = 8), which could not be correctly assessed until after skeletal maturation was complete. Without any active orthodontic treatment, compensatory growth of the alveolar processes closed the lateral open bites, which were created during surgery. The functional results of the reconstructed temporo-mandibular joints were good and the morbidity rate was low. Costochondral grafting is a versatile treatment when the TMJs are severely affected by JCA, but requires supervision of patients until skeletal maturation, to monitor possible mandibular overgrowth. Advantages of this method were re-established mandibular growth, good mandibular function, a low morbidity rate and early aesthetic improvement.

Osseointegration of implants in irradiated bone with and without hyperbaric oxygen treatment : an experimental study in rat Tibiae

PURPOSE Hyperbaric oxygen (HBO) has been recommended to enhance implant osseointegration in irradiated bone. The aim of this study was to further investigate the effects of HBO on implant integration in irradiated bone tissue. MATERIALS AND METHODS The present study was an experimental intraindividual study in 16 rats. A single fraction of 20 Gy external irradiation was applied to one rat hind leg, while the other served as a nonirradiated control. Three days after radiation, two implants were inserted in each tibial tuberosity. The rats were divided into two groups: non-HBO treated (group 1) and HBO treated (group 2). Five weeks after radiation, removal torque tests were performed. Implants with surrounding tissue were processed to undecalcified cut and ground sections for histomorphometric evaluations of bone-to-implant contact and bone area. Retrieved bones were also investigated with dual-energy x-ray absorptiometry. RESULTS The non-HBO treated rats (group 1) demonstrated higher, but not statistically significantly higher, values in the nonirradiated leg for all investigated parameters compared to the HBO-treated rats (group 2). However, the mean value for bone area was significantly higher in the irradiated sides compared to the nonirradiated control sides. CONCLUSIONS In the present study, HBO treatment did not have a significant impact on osseointegration of implants in irradiated bone.

Auricular cartilage grafting in arthroplasty of the temporomandibular joint: a retrospective clinical follow-up

OBJECTIVE The aim of this study was to evaluate TMJ arthroplasty with auricular cartilage grafts in patients with osteoarthritis, refractory to previous surgical and nonsurgical treatment. STUDY DESIGN Twenty-three TMJs in 18 patients where arthroplasty with auricular cartilage grafts had been performed were evaluated. Sixteen joints in 12 patients with grafts still in position were followed. TMJ pain at mandibular function, TMJ tenderness and mouth opening ability (MIO) were evaluated. RESULTS The grafts had to be removed from 7 TMJs (30%), all of which had been subject to previous surgery. In the 16 joints with grafts still in position a significant (P < .001) reduction of pain at mandibular function was found and MIO had increased significantly (P = .015). CONCLUSIONS TMJ arthroplasty with auricular cartilage grafts can reduce pain and improve mandibular function in patients with osteoarthritis. The method seems to be less favorable in patients where previous TMJ surgery has been performed.

Growth of costochondral grafts in reconstruction of the mandibular condyle: an experimental study in domestic pigs

Reconstruction of the mandibular condyle with costochondral grafts (CCGs) in children may result in overgrowth at the reconstructed side of the mandible. In this study we report on the effects of functional stimuli on growth and morphology of growth plates of CCGs used for immediate mandibular condyle replacement in 10 juvenile pigs. The mandibular condyles were resected unilaterally and immediately reconstructed with autogenous CCGs. Another CCG was placed submuscularly on one tibia. The lengths of both CCGs and of one rib before resection were measured at operation and 12 weeks later. The grafts were labelled with intraperitoneal injections of oxytetracycline and alizarin eight and 12 weeks postoperatively, respectively. The extent of growth of the CCGs in the two environments was similar, so we concluded that the functional stimuli in the TMJ environment had only a minor influence on the extent of growth of the CCGs. The morphology of the growth plate of the CCGs had changed considerably.Reconstruction of the mandibular condyle with costochondral grafts (CCGs) in children may result in overgrowth at the reconstructed side of the mandible. In this study we report on the effects of functional stimuli on growth and morphology of growth plates of CCGs used for immediate mandibular condyle replacement in 10 juvenile pigs. The mandibular condyles were resected unilaterally and immediately reconstructed with autogenous CCGs. Another CCG was placed submuscularly on one tibia. The lengths of both CCGs and of one rib before resection were measured at operation and 12 weeks later. The grafts were labelled with intraperitoneal injections of oxytetracycline and alizarin eight and 12 weeks postoperatively, respectively. The extent of growth of the CCGs in the two environments was similar, so we concluded that the functional stimuli in the TMJ environment had only a minor influence on the extent of growth of the CCGs. The morphology of the growth plate of the CCGs had changed considerably.