Imaging Sci Dent.  2016 Dec;46(4):279-284. 10.5624/isd.2016.46.4.279.

Long-standing chin-augmenting costochondral graft creating a diagnostic challenge: A case report and literature review

• Badr FF
• Mintline M
• Ruprecht A
• Cohen D
• Blumberg B
• Nair MK

• KMID: 2362747
• DOI: http://doi.org/10.5624/isd.2016.46.4.279

Abstract

To our knowledge, the imaging features of costochondral grafts (CCGs) on cone-beam computed tomography (CBCT) have not been documented in the literature. We present the case of a CCG in the facial soft tissue to the anterior mandible, with changes mimicking a cartilaginous neoplasm. This is the first report to describe the CBCT imaging features of a long-standing graft in the anterior mandible. Implants or grafts may be incidental findings on radiographic images made for unrelated purposes. Although most are well-defined and radiographically homogeneous, being of relatively inert non-biological material, immune reactions to some grafts may stimulate alterations in the appearance of surrounding tissues. Biological implants may undergo growth and differentiation, causing their appearance to mimic neoplastic lesions. We present the case of a cosmetic autogenous CCG that posed a diagnostic challenge both radiographically and histopathologically.

Keyword

Cone-Beam Computed Tomography; Mandibular Reconstruction; Genioplasty

MeSH Terms

Cone-Beam Computed Tomography
Genioplasty
Incidental Findings
Mandible
Mandibular Reconstruction
Transplants*

Figure

• 

  Fig. 1 A panoramic reconstructed cone-beam computed tomographic image shows the extent of the lesion from the mandibular left premolar area to the mesial aspect of mandibular right third molar, and from the level of the root apices through the inferior border of the mandible.

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  Fig. 2 Multiplanar reconstruction images such as axial (A), sagittal (B), coronal (C), and 3-dimensional reconstruction (D) images show the heterogeneously radiopaque mass in the chin area. Note the effacement of the labial cortical plate and the altered jaw morphology. The lingual cortical plate is thinned in one area (arrow).

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  Fig. 3 A cross-sectional (orthoradial) image through the right parasymphyseal region of the mandible shows the heterogeneity of the mass. Multiple small radiopaque masses suggestive of a cartilaginous neoplasm are present.

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  Fig. 4 A 3-dimensional volumetric rendering image reveals the mixed radiopaque and radiolucent appearance of the chin area, consistent with the appearance in Figure 3.

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  Fig. 5 A photomicrograph shows benign hyaline cartilage and adherent fibrosis (H&E stain, original magnification ×100).

Reference

1. Rollnick BR, Kaye CI, Nagatoshi K, Hauck W, Martin AO. Oculoauriculovertebral dysplasia and variants: phenotypic characteristics of 294 patients. Am J Med Genet. 1987; 26:361–375.

2. Gorlin RJ, Jue KL, Jacobsen U, Goldschmidt E. Oculoauriculovertebral dysplasia. J Pediatr. 1963; 63:991–999.

3. Pashayan H, Pinsky L, Fraser FC. Hemifacial microsomia -oculo-auriculo-vertebral dysplasia. A patient with overlapping features. J Med Genet. 1970; 7:185–188.

4. Cohen MM Jr, Rollnick BR, Kaye CI. Oculoauriculovertebral spectrum: an updated critique. Cleft Palate J. 1989; 26:276–286.

5. Poswillo D. The pathogenesis of the first and second branchial arch syndrome. Oral Surg Oral Med Oral Pathol. 1973; 35:302–328.

6. Beleza-Meireles A, Clayton-Smith J, Saraiva JM, Tassabehji M. Oculo-auriculo-vertebral spectrum: a review of the literature and genetic update. J Med Genet. 2014; 51:635–645.

7. The free dictionary by FARLEX. Medical-dictionary.thefreedictionary.com [Internet]. cited 2016 April 4. Available from: http://medical-dictionary.thefreedictionary.com.

8. Schatz CJ, Ginat DT. Imaging of cosmetic facial implants and grafts. AJNR Am J Neuroradiol. 2013; 34:1674–1681.

9. Yang S, Fan H, Du W, Li J, Hu J, Luo E. Overgrowth of costochondral grafts in craniomaxillofacial reconstruction: rare complication and literature review. J Craniomaxillofac Surg. 2015; 43:803–812.

10. Eckardt A, Swennen G, Teltzrow T. Melanotic neuroectodermal tumor of infancy involving the mandible: 7-year follow-up after hemimandibulectomy and costochondral graft reconstruction. J Craniofac Surg. 2001; 12:349–354.

11. Kaban LB, Perrott DH, Fisher K. A protocol for management of temporomandibular joint ankylosis. J Oral Maxillofac Surg. 1990; 48:1145–1151.

12. Kansy K, Mueller AA, Mucke T, Kopp JB, Koersgen F, Wolff KD, et al. Microsurgical reconstruction of the head and neck -current concepts of maxillofacial surgery in Europe. J Craniomaxillofac Surg. 2014; 42:1610–1613.

13. Ko EW, Huang CS, Chen YR. Temporomandibular joint reconstruction in children using costochondral grafts. J Oral Maxillofac Surg. 1999; 57:789–798.

14. Nelson CL, Buttrum JD. Costochondral grafting for posttraumatic temporomandibular joint reconstruction: a review of six cases. J Oral Maxillofac Surg. 1989; 47:1030–1036.

15. Obeid G, Guttenberg SA, Connole PW. Costochondral grafting in condylar replacement and mandibular reconstruction. J Oral Maxillofac Surg. 1988; 46:177–182.

16. Fukuta K, Jackson IT, Topf JS. Facial lawn mower injury treated by a vascularized costochondral graft. J Oral Maxillofac Surg. 1992; 50:194–198.

17. Raustia A, Pernu H, Pyhtinen J, Oikarinen K. Clinical and computed tomographic findings in costochondral grafts replacing the mandibular condyle. J Oral Maxillofac Surg. 1996; 54:1393–1400.

18. Samman N, Cheung LK, Tideman H. Overgrowth of a costochondral graft in an adult male. Int J Oral Maxillofac Surg. 1995; 24:333–335.

19. Mallya SM, Lurie AG. Panoramic imaging. In : White SC, Pharoah MJ, editors. Oral radiology: principles and interpretation. 7th ed. St. Louis, Mo.: Mosby/Elsevier;2014. p. 166–184.

20. Jang HW, Kim NK, Lee WS, Kim HJ, Cha IH, Nam W. Mandibular condyle and infratemporal fossa reconstruction using vascularized costochondral and calvarial bone grafts. J Korean Assoc Oral Maxillofac Surg. 2014; 40:83–86.

21. Karacaoğlan N, Akbas H, Eroğlu L, Ioncesu L. Chin augmentation using diced cartilage. Eur J Plast Surg. 1998; 21:254–256.

22. Loftus MJ, Bennett JA, Fantasia JE. Osteochondroma of the mandibular condyles. Report of three cases and review of the literature. Oral Surg Oral Med Oral Pathol. 1986; 61:221–226.

23. Garrington GE, Collett WK. Chondrosarcoma. II. Chondrosarcoma of the jaws: analysis of 37 cases. J Oral Pathol. 1988; 17:12–20.