Periosteum preservation facilitates osteogenesis after costochondral grafting in patients with hemifacial microsomia: a cohort study.

Abstract

Costochondral graft (CCG) are the preferred treatment for Kaban-Pruzansky type IIB/III hemifacial microsomia (HFM) in children. However, debate persists regarding whether the periosteum and perichondrium should be preserved during surgery. This retrospective clinical study evaluated the role of periosteal and perichondral preservation in CCG transplantation. Twenty-one consecutive patients with HFM who underwent CCG transplantation for mandibular ramus reconstruction were included. Based on whether the periosteum and perichondrium were preserved, patients were categorized into the periosteum-preserved (PP) group (n = 12) and the periosteum-stripped (PS) group (n = 9). Demographic data, surgical details, treatment outcomes, and postoperative complications were recorded. Three-dimensional computed tomography scans obtained immediately postoperatively and at 18-24-month follow-up were analyzed to assess osteogenesis. In the PP group, graft length increased by 3.39 mm, volume expanded by 223.25 mm³, and ramus height increased by 3.94 mm. Conversely, the PS group showed a graft length increase of only 0.44 mm, a volume decrease of 76.05 mm³, and a ramus height reduction of 0.93 mm. These differences were statistically significant (p ≤ 0.05). The PP group demonstrated improved mandibular symmetry, with an increased ramus height ratio and stable hemimandibular volume ratio. Conversely, the PS group exhibited reductions in both metrics. Notably, the incidence of pseudarthrosis formation was significantly higher in the PP group (p ≤ 0.05). Preservation of the periosteum and perichondrium during CCG implantation enhances postoperative bone fusion, remodeling, and growth in patients with HFM.