Bone Grafts

Reconstruction of bony defects with autogenous bone grafts is an integral part of modern treatment concepts in traumatology of the craniofacial skeleton (Tessier 1982; Jackson et al. 1983, 1987; Gruss et al. 1985; Gruss 1986; Marentette 1988; Ilankovan and Jackson 1992; Hammer 1995, 2002; Zins et al. 1995, 1999; Prein 1998; Maniglia et al. 1999; Dempf et al. 1998; Donald 1998; Frodel 2002; Greenberg and Prein 2002).

Whereas accurate primary bone defect coverage can achieve excellent aesthetic and functional results, secondary reconstruction often does not provide ­satisfactory results. The indication for autogenous bone grafts should, therefore, be liberally made during the primary intervention (Gruss 1986; Jackson et al. 1987; Salyer 1989; Whitaker 1989; Ilankovan and Jackson 1992; Manson 1994, 1998a; Hammer 1995; Dempf et al. 1998; Frodel 2002).

In cases of substantial bone loss, the integration of bone grafts results in an improved fracture stabilization and has a preventative function against midfacial collapse (midfacial elongation or shortening) (Klotch and Gilliland 1987).

•On the other hand, disfiguring facial contours from scarring or soft tissue contractions overlying the deficient osseous structures can also be avoided (Gruss et al. 1985; Manson et al. 1985; Gruss and Mc Kinnon 1986; Gruss and Philipps 1989; Mathog 1992; Salyer 1992; Härle et al. 1999; Frodel 2002).

Due to excellent stability achieved by plate and screw fixation, the necessity of primary bone grafting has been reduced (Stanley and Schwartz 1989; Härle et al. 1999).

10.1  Indications

There are several indications for using bone grafts to reconstruct osseous defects:

10.1.1  Midface

(Manson et al. 1985; Marentette 1988; Gruss and Mc Kinnon 1986; Serletti and Manson 1992; Frodel 2002)

•The primary and simultaneous insertion of bone grafts to cover bony defects or to bridge gaps in the area of the load-bearing maxillary pillars is a radical improvement in maxillofacial fracture treatment.

10.1.2  Frontofacial Region (Gruss and

Mc Kinnon 1986; Serletti and

Manson 1992; Frodel 2002)

•Untreated fronto-cranial bone defects do not heal spontaneously and result in soft tissue retractions and conspicuous deformations, especially in aesthetically important regions.

•A complete osseous reconstruction protects the brain and provides a functional platform for the mimical muscles.

•Apart from anatomically correct repositioning and stabilizing of all fragments, it is necessary to fill remaining­ gaps, defects, and trepanation holes to avoid subsequent contour irregularities (Jackson et al. 1986; Sailer and Graetz 1991; Dufresne et al. 1992; Hardt et al. 1992, 1994, Lee et al. 1998).