Is transport distraction osteogenesis superior to autogenous costochondral graft for joint reconstruction in temporomandibular joint ankylosis? A systematic review and meta-analysis

Purpose: A spectrum of surgical management for temporomandibular joint (TMJ) ankylosis exists ranging from gap arthroplasty to total joint replacement. Reconstruction and rehabilitation of the ramus-condyle unit (RCU) remains a surgical challenge in TMJ ankylosis. Distraction osteogenesis (DO) is a promising technique for joint reconstruction over conventional methods. This review compared the clinically relevant outcomes of transport distraction osteogenesis (TDO) and costochondral graft (CCG) for joint reconstruction in TMJ ankylosis. Methods: PubMed, Medline, Embase, CENTRAL and ScienceDirect databases were searched from inception till 30th September 2023. Randomized controlled trials (RCTs) and prospective, retrospective studies on TMJ ankylosis patients comparing TDO and CCG for joint reconstruction and reporting outcomes were included. Assessment of the risk of bias was done with the Cochrane Collaboration tool. Results: Five studies were included in the review. A significant improvement in the postoperative mouth opening with both groups was reported on follow-up and the analysis favored TDO for the joint reconstruction (p = 0.003). TDO group reported up to 6.1 % lower incidence of postoperative reankylosis in comparison to CCG (p = 0.59). Data was insufficient with regard to facial asymmetry, chin deviation and malocclusion. Conclusion: TDO is a better alternative to CCG for joint reconstruction. Due to paucity of the reported literature and unequal sample distribution between the groups, quality evidence could not be derived regarding long-term stability. Further RCTs are recommended to generate better evidence and evaluate clinically relevant outcomes.