Hydroxyapatite collagen scaffold with autologous bone marrow aspirate for mandibular condylar reconstruction

Publication date: Available online 6 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Debraj Howlader, U. Vignesh, Dichen P. Bhutia, Rahul Pandey, Sumit Kumar, Tulika Chandra, Divya Mehrotra
PurposeThis study was designed with the aim to assess the efficiency of hydroxyapatite/collagen (HA/Col) bio-scaffold with bone marrow aspirate (BMA) to reconstruct mandibular condyle in patients with temporomandibular joint (TMJ) ankylosis.Materials and MethodsSeven pediatric patients with TMJ ankylosis, who visited our outpatient clinic and whose parents opted for this procedure, were included in this study. After a history and clinical examination for TMJ movements, computed tomography (CT) scans were obtained. Interposition arthroplasty, with or without coronoidectomy, was performed to gain at least 35 mm of mouth opening. A 2-ml quantity of BMA was aspirated from the posterior iliac crest. A HA/Col block was carved to shape the condyle, and was fixed to the ramus using a plate and screws. A collagen sponge soaked in BMA was interposed in between the graft and ramal end, and the temporal fascia was rotated between the glenoid fossa and graft. Physiotherapy was started on postoperative day 10. All patients were followed up for 1 year. Success was graded on the basis of the mouth opening and TMJ score based on efficiency of chewing, speech, activity, recreation, mood, and anxiety on a five-point ordinal scale.ResultsThe mean age was 9.71 years (range 5-14 years), and the male-to-female ratio was 5:2. The mean preoperative mouth opening was 4.14 mm, which improved to 34.57 mm at 1-year follow-up. The mean protrusive movement improved from 0 to 2.86 mm. The mean success score was 4.43 out of 5. The mean TMJ score improved from 2.38 to 3.94.ConclusionA HA/Col bio-scaffold with bone marrow aspirate is a safe and cost-effective alternative for reconstruction of the mandibular condyle, particularly in growing individuals with high osteogenic potential.



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