Midfacial reconstruction using calvarial split bone grafts.
OBJECTIVE
To evaluate the success rate of free calvarial grafts for midfacial reconstruction, the relevance of soft tissue coverage, and the influence of radiotherapy.


METHODS
Retrospective analysis.


METHODS
University medical center.


METHODS
Fifty-six patients (27 tumor cases, 24 trauma cases, and 5 others) underwent bony midface reconstruction using calvarial grafts in the past 11 years. Half of the patients with tumor were additionally treated with radiation.


METHODS
A total of 95 bone transplants were used for reconstruction of the zygoma, orbit, and nasal bone. Graft survival and complications were evaluated. Grafts with total and partial soft tissue coverage were compared. The influence of radiotherapy in the tumor patient group was determined.


RESULTS
Graft survival was 95.8%. One nasal dorsum graft was totally resorbed. Infection occurred in 9 cases, leading to only 1 total and 2 partial graft losses. The incidence of dysfunction of the eye due to globe malposition after reconstruction of the orbital walls was low. A correlation between radiation and transplant loss as well as between soft tissue coverage and graft survival could not be found.


CONCLUSIONS
For midfacial reconstruction, it is not necessary to fully cover calvarial bone grafts by the surrounding soft tissue. Even in patients who will undergo postoperative irradiation, calvarial bone grafts are a reliable alternative in selected cases.
Smolka
Wenko
W
Department of Cranio-Maxillofacial Surgery, University of Berne, CH-3010 Berne, Switzerland. wenko.smolka@insel.ch
Eggensperger
Nicole
N
Kollar
Andrea
A
Iizuka
Tateyuki
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D005147:Facial Bones / Q000293:injuries* / Q000601:surgery*; D005151:Facial Injuries / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012886:Skull / Q000637:transplantation*; D014057:Tomography, X-Ray Computed; D015050:Zygoma / Q000601:surgery