Costochondral Graft Reconstruction of the Temporomandibular Joint: Long-Term Functional Outcomes and Growth-Related Complications

BACKGROUND: Long-term outcomes of autogenous costochondral graft (CCG) reconstruction of the temporomandibular joint (TMJ) remain poorly characterized because most published series truncate follow-up at ≤10 years and pool heterogeneous indications. We aimed to evaluate sustained functional improvement and growth-related complications over up to 3 decades of follow-up. METHODS: This single-center retrospective cohort included 12 consecutive patients (3 skeletally immature, 9 mature; ages 12-71) who underwent CCG-TMJ reconstruction between January 1996 and December 2011, with chart and imaging review through January 2025. The primary endpoint was maximum mouth opening (MMO; mm) measured at preoperative baseline (T0), immediate postoperative (T1), and final follow-up (T3). Secondary endpoints were operated-side ramus-condyle unit (RCU) length change and surgical complications. MMO trajectories were analyzed using a linear mixed-effects model with random patient intercepts and time as a fixed effect, with Bonferroni-adjusted pairwise contrasts. RCU change was compared between growth subgroups using the exact two-sided Mann-Whitney U test, with a Hodges-Lehmann (HL) point estimate and rank-biserial r as effect size. Given small subgroup sizes, RCU comparisons are presented as descriptive-exploratory. RESULTS: Mean follow-up was 11.1±7.8 years (range 3-31). Mean MMO improved from 15.8±6.3 mm at T0 to 34.6±6.3 mm at T1 (Δ+18.8 mm, 95% CI 14.5-23.1; P