The use of vascularized cranial bone in reconstruction of the maxilla and mandible

Abstract

Defects of the maxilla and mandible can cause significant functional and aesthetic problems for patients. Vascularized calvarium was used to reconstruct six mandible and four maxillary defects between 1991 and 1998. The ages of patients ranged from 15 to 68 years.Full thickness calvarial bone was preferred for the repair of segmental mandibular defects but split thickness calvarial bone onlay was used to reconstruct contour deformities. When full thickness calvarial bone was used, the donor site defect was covered with split thickness cranial bone. In small defects, a bipedicled galea pericranial flap was used for reconstruction. The bone was supplied by the superficial temporal vessels in all cases. A tunnel in the subcutaneous plane was used for the flap transfer to avoid facial nerve branches. Immediate expansion was performed during the preparation of the tunnel to prevent pedicle compression. Bone vascularization was checked with bone scan and serial X-rays and clinical examinations were also performed in the postoperative period. Flap necrosis was observed in one case, satisfactory functional and aesthetic results were achieved in all other patients. Vascularized cranial bone has not only the same structural features as facial bones but also a reliable vascular supply. The superficial temporal fascia and hairy skin may be included in the cranial bone flap to treat complex defects. The donor site scar is well hidden in the scalp. There is minimal donor site discomfort. In conclusion, vascularized cranial bone is a good method of treatment in selected cases.