Emeritus professor of Maxillofacial Surgery, Iraqi Board for Medical Specializations, Baghdad, Iraq
Received: 15 June, 2016; Accepted: 22 August, 2017; Published: 24 August, 2017
Raja Kummoona, FDSRCS, FICD, Emeritus professor of Maxillofacial Surgery, Iraqi Board for Medical Specializations, Baghdad, Iraq, E-mail:
Kummoona R. (2017) Kummoona Chondro-Ossous graft good substitute to condylar growth center and fore correction of facial deformity in chilidren. Arch Otolaryngol Rhinol 3(3): 098-102. DOI: 10.17352/2455-1759.000057
© 2017 Kummoona R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Chondro-Ossous graft; TMJ; Facial deformity; Reconstruction; Rabbit
Kummoona Chondro-Ossous graft is the most popular graft been used for reconstruction of the temporomandibular joint for restoring growth, repair and remodeling and fore correction of facial deformity in children with restoration of functional activity of the damaged temporomandibular joint (TMJ) and graft work as primary growth center. These graft been studied by experiment on Rabbits as an excellent animal model for viability of the graft. clinically 36 cases were reported, they were 25 children including 9 females and sixteen boys with history of ankyloses of the TMJ and ten children of 4 females and 6 boys suffering from milled hemi facial microsomia or first arch dysplasia syndrome and one female case with traumatic hypoplasia of the condyle.
Fellow up of the cases from 3-5 years and graft does not showed any ossification or chondrifacation beside its function for restoring growth, remodeling and repair on the long run.
There are a lot of controversial views about the condyle as a growth center, the British pioneer and great scientist John Hunter  1772-1773 who paid attention to the condyle as a growth center in his book the teeth and he mentioned in his book there is a strong relation between the teeth and temporomandibular joint( TMJ).
This theory was accepted by most of the scientist and clinician for many decades till Moss , 1962 came with new theory based on, the growth of the face occurred as a functional demand of the periosteal matrix of the facial skeleton and he think there is no growth center in the condyle controlling the growth of the mandible and most of the craniofacial and maxillofacial surgeons with orthodontist were supported Moss theory previously .
The author came with another idea and supported John Hunter theory , his thought was based on his experimental studies by using Rabbits as animal model for his experiments by excision the head of the Rabbit condyle of the mandible of a newly borne animal and three months later he noticed severe deformity of the mandible and mid face ,and the mandible twisted to the effected side and also the author did replaced the TMJ by two part chrome cobalt Kummoona prosthesis , for ankylosed joint of 6 year female patient, after three years he noticed this young girl showed excellent function of the mandible during mouth opening without difficulties during mastication but she had some deficiency in the growth of the mandible on the of joint replacement side by prosthesis .
The author believed, there is no single theory controlling the growth of the mandible and mid face but both theories working together for growth of the mandible and the face and the condyle work as growth center combined with the Moss theory of functional demand of the periosteal matrix of the facial skeleton [4,5].
During the last 4 decades there were a lot of researchers attempting to use an autologous tissue to replace the damage condyle and the temporomandibular joint (TMJ) by different technique applied clinically on human or experimentally on animal models, these attempts were failed to restore growth and function of the condyle and temporomandibular joint.
A number of different autologous tissues have been used in attempt to restore normal height and reconstruct the TMJ articulation with restoration of function. The attempts of Bardenheur  and Gilles  both described the use of costochondral graft, this technique has been revised and subjected to scientific scrutiny in the last 4 decades and the pioneers were Johan Kennet  and David poswillo 1974 [9,10].
In children the author proposed and advocates a new technique to substitute the costochondral graft with a Chondro-Ossous graft from iliac crest for restoration of growth, repair, remodeling, and height of midface and function of the TMJ.
Material and Methods
Thirty six cases were reported, there were 25 children including 9 female and 16 boys with history of ankyloses of the TMJ and ten children of four females and six boys with history of under developed mandible and milled hemi facial microsomia and one female with hypoplasia of the condyle due to trauma, their age ranged between 4 and 13 years (mean 8.5) and fellow up of the cases ranged from 3-6 years. All these cases were treated in the Surgical Specialty hospital, Medical City and author private clinic (Figures 1 A,B, Figures 2 A-D).