Arnaud M Gleizal1, Jean-Luc E Beziat. 1. Department of Maxillofacial, Plastic, and Reconstructive Surgery, Lyon Nord Medical Center, Lyon, France.
Abstract
BACKGROUND: Using classic maxillary and mandibular reconstruction with mandibular bone grafts or unicortical calvarial bone grafts, the authors performed 122 reconstructions in 73 patients using bicortical calvarial bone grafts and report the results in this article. Such a technique has not been previously described in the world literature. METHODS: Seventy-three patients, 55 women and 18 men, with severely atrophied maxillas or mandibles were treated with bicortical calvarial bone grafts and placement of implants over a 5-year period. Patient selection was based on the important insufficient remaining height or width of bone placement of multiple 10-mm implants and the thinness of the calvaria (<5 mm). All patients had major bone atrophy. RESULTS: Twenty-nine patients had 121 implants placed in vertical bicortical bone grafts and 40 patients had 170 implants placed in horizontal bicortical bone grafts. All patients underwent a two-stage procedure, with the implants being placed 4 to 5 months after the grafting procedure. The majority of maxillary implants were placed between the canine eminence and zygomatic buttress. Of the 122 bicortical calvarial bone grafts that took, two cases presented an incised wound of the dura. A simple nonabsorbable suture was performed in these two cases without any postoperative problems. There were no cerebral injuries encountered with the donor sites. CONCLUSIONS: Bicortical bone grafting seems to be a solution for reconstruction of voluminous bone atrophy in cases of thin calvaria. Because of legal issues, such a technique must be performed by a trained craniofacial surgery team. The resorption rate seems to be lower in cases of bicortical bone graft.
BACKGROUND: Using classic maxillary and mandibular reconstruction with mandibular bone grafts or unicortical calvarial bone grafts, the authors performed 122 reconstructions in 73 patients using bicortical calvarial bone grafts and report the results in this article. Such a technique has not been previously described in the world literature. METHODS: Seventy-three patients, 55 women and 18 men, with severely atrophied maxillas or mandibles were treated with bicortical calvarial bone grafts and placement of implants over a 5-year period. Patient selection was based on the important insufficient remaining height or width of bone placement of multiple 10-mm implants and the thinness of the calvaria (<5 mm). All patients had major bone atrophy. RESULTS: Twenty-nine patients had 121 implants placed in vertical bicortical bone grafts and 40 patients had 170 implants placed in horizontal bicortical bone grafts. All patients underwent a two-stage procedure, with the implants being placed 4 to 5 months after the grafting procedure. The majority of maxillary implants were placed between the canine eminence and zygomatic buttress. Of the 122 bicortical calvarial bone grafts that took, two cases presented an incised wound of the dura. A simple nonabsorbable suture was performed in these two cases without any postoperative problems. There were no cerebral injuries encountered with the donor sites. CONCLUSIONS: Bicortical bone grafting seems to be a solution for reconstruction of voluminous bone atrophy in cases of thin calvaria. Because of legal issues, such a technique must be performed by a trained craniofacial surgery team. The resorption rate seems to be lower in cases of bicortical bone graft.