Paediatric temporomandibular joint ankylosis (TMJA) is a debilitating condition that impairs mandibular function and disrupts normal craniofacial growth. Costochondral graft (CCG) reconstruction has been widely used due to its biological compatibility and presumed growth potential; however, its long-term behaviour remains controversial. Purpose was to systematically evaluate the functional outcomes and growth potential of costochondral graft reconstruction in paediatric TMJA.

A systematic review was conducted in accordance with PRISMA guidelines. Electronic databases, including PubMed, Scopus, Web of Science, and Google Scholar, were searched from inception to December 2025. Studies involving paediatric patients (3–16 years) undergoing TMJ reconstruction with costochondral grafts, with a minimum sample size of 10 and follow-up of at least 1-year, were included. The primary outcome was maximal incisal opening (MIO), while secondary outcomes included mandibular growth, re-ankylosis, facial asymmetry, and complications. Data were synthesised qualitatively due to heterogeneity among studies.

Six studies comprising 92 patients (107 joints) were included. All studies demonstrated significant improvement in MIO, with postoperative values generally exceeding 30 mm, indicating consistent functional recovery. Re-ankylosis was reported in 7 cases (7.6%). Growth outcomes were variable, ranging from satisfactory mandibular development to overgrowth and undergrowth, reflecting the unpredictable nature of CCG behaviour. Facial symmetry improved in most patients, although residual deformity was observed in cases with abnormal graft growth. Complications included facial nerve paresis in 11 patients (11.9%), graft overgrowth in 8 (8.7%), and rare instances of graft resorption, fracture, pneumothorax, and perichondritis.

Costochondral graft reconstruction in paediatric temporomandibular joint ankylosis appears to provide consistent improvement in functional outcomes, particularly in terms of mouth opening. However, the evidence regarding its growth potential remains variable and unpredictable. While CCG continues to be a useful reconstructive option in growing patients, careful patient selection and long-term follow-up are essential. Further well-designed prospective studies with standardized outcome measures are required to establish more reliable and generalizable conclusions.