Calvarial Bone Grafting of Facial Defects

Bony defects of the face continue to challenge the reconstructive surgeon. Traditional sources of autologous bone from the rib or pelvis have been associated with the limitations of pain at the donor site, the need for a second operative field, variable “take” of the graft with poor eventual survival and, ultimately, less than optimal reconstruction. Calvarial bone grafting provides a readily accessible source of bone from an inconspicuous donor site, usually within the same operative field. The morbidity is minimal. The calvarial bone graft is especially useful in repair of the frontal sinus, orbital floor, nasal and malar regions, as well as in certain instances of cleft palate with alveolar involvement.

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Posterior frontal sinus wall: A unique calvarial bone donor site

Operative Techniques in Otolaryngology-Head and Neck Surgery ◽

10.1053/otot.2000.19709 ◽

2000 ◽

Vol 11 (4) ◽

pp. 307-312

Author(s):

Aharon Amir ◽

Eyal Gur ◽

Albert Gatot ◽

Gideon Zucker ◽

Jacob T. Cohen ◽

...

Keyword(s):

Frontal Sinus ◽

Donor Site ◽

Calvarial Bone ◽

Sinus Wall

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Bone Morphogenetic Proteins in Craniofacial Surgery: Current Techniques, Clinical Experiences, and the Future of Personalized Stem Cell Therapy

Journal of Biomedicine and Biotechnology ◽

10.1155/2012/601549 ◽

2012 ◽

Vol 2012 ◽

pp. 1-14 ◽

Cited By ~ 32

Author(s):

Kristofer E. Chenard ◽

Chad M. Teven ◽

Tong-Chuan He ◽

Russell R. Reid

Keyword(s):

Stem Cell ◽

Bone Morphogenetic Proteins ◽

Bone Grafting ◽

Donor Site ◽

Donor Site Morbidity ◽

Experimental Models ◽

Craniofacial Surgery ◽

Cell Therapies ◽

Autologous Bone Grafting ◽

Autologous Bone

Critical-size osseous defects cannot heal without surgical intervention and can pose a significant challenge to craniofacial reconstruction. Autologous bone grafting is the gold standard for repair but is limited by a donor site morbidity and a potentially inadequate supply of autologous bone. Alternatives to autologous bone grafting include the use of alloplastic and allogenic materials, mesenchymal stem cells, and bone morphogenetic proteins. Bone morphogenetic proteins (BMPs) are essential mediators of bone formation involved in the regulation of differentiation of osteoprogenitor cells into osteoblasts. Here we focus on the use of BMPs in experimental models of craniofacial surgery and clinical applications of BMPs in the reconstruction of the cranial vault, palate, and mandible and suggest a model for the use of BMPs in personalized stem cell therapies.

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Evaluation of Alveolar Bone Grafting: A Survey of ACPA Teams

The Cleft Palate-Craniofacial Journal ◽

10.1597/03-045.1 ◽

2005 ◽

Vol 42 (1) ◽

pp. 99-101 ◽

Cited By ~ 37

Author(s):

Ananth S. Murthy ◽

James A. Lehman

Keyword(s):

North America ◽

Cleft Palate ◽

Bone Grafting ◽

Iliac Crest ◽

Alveolar Bone ◽

Donor Site ◽

X Rays ◽

Alveolar Bone Grafting ◽

Missing Tooth

Objective To evaluate the management of alveolar clefts by cleft palate and craniofacial teams in North America. Design An anonymous survey was mailed to 240 American Cleft Palate– Craniofacial Association teams across North America regarding alveolar bone grafting. The questionnaire included multiple questions about each team's approach to alveolar bone grafting and options for the missing tooth. Results Consensus was achieved in three areas: 90% of centers performed secondary alveolar bone grafting, 78% performed grafting between ages 6 and 9 years, and iliac crest donor site was the most popular site (83%). There was no consensus with respect to dental criteria for the timing of grafting, follow-up x-rays, or the use of a grading system for evaluating results. In addition, there was no consensus on the management of the missing tooth. Conclusion There is wide acceptance of secondary bone grafting and there is a consensus for the age of grafting (6 to 9 years) and donor site (iliac crest). The disturbing finding was the lack of postoperative x-ray evaluation of the results. With so much variability in management, the use of a routine, standardized scale to measure postoperative results would allow for better outcome studies in alveolar bone grafting.

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Combination of a Bioceramic Scaffold and Simvastatin Nanoparticles as a Synthetic Alternative to Autologous Bone Grafting

International Journal of Molecular Sciences ◽

10.3390/ijms19124099 ◽

2018 ◽

Vol 19 (12) ◽

pp. 4099 ◽

Cited By ~ 1

Author(s):

Chau-Zen Wang ◽

Yan-Hsiung Wang ◽

Che-Wei Lin ◽

Tien-Ching Lee ◽

Yin-Chih Fu ◽

...

Keyword(s):

Bone Healing ◽

Bone Grafting ◽

Rabbit Model ◽

Bone Grafts ◽

Poly Lactic Acid ◽

Sprague Dawley ◽

Calvarial Bone ◽

Autologous Bone Grafting ◽

Porous Bioceramic ◽

Autologous Bone

The fragile nature of porous bioceramic substitutes cannot match the toughness of bone, which limits the use of these materials in clinical load-bearing applications. Statins can enhance bone healing, but it could show rhabdomyolysis/inflammatory response after overdosing. In this study, the drug-containing bone grafts were developed from poly(lactic acid-co-glycolic acid)-polyethylene glycol (PLGA-PEG) nanoparticles encapsulating simvastatin (SIM) (SIM-PP NPs) loaded within an appropriately mechanical bioceramic scaffold (BC). The combination bone graft provides dual functions of osteoconduction and osteoinduction. The mechanical properties of the bioceramic are enhanced mainly based on the admixture of a combustible reverse-negative thermoresponsive hydrogel (poly(N-isopropylacrylamide base). We showed that SIM-PP NPs can increase the activity of alkaline phosphatase and osteogenic differentiation of bone marrow stem cells. To verify the bone-healing efficacy of this drug-containing bone grafts, a nonunion radial endochondral ossification bone defect rabbit model (N = 3/group) and a nonunion calvarial intramembranous defect Sprague Dawley (SD) rat model (N = 5/group) were used. The results indicated that SIM-PP NPs combined with BC can improve the healing of nonunion bone defects of the radial bone and calvarial bone. Therefore, the BC containing SIM-PP NPs may be appropriate for clinical use as a synthetic alternative to autologous bone grafting that can overcome the problem of determining the clinical dosage of simvastatin drugs to promote bone healing.

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Autologous Bone Grafting in Trauma and Orthopaedic Surgery: An Evidence-Based Narrative Review

Journal of Clinical Medicine ◽

10.3390/jcm10194347 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4347

Author(s):

Filippo Migliorini ◽

Francesco Cuozzo ◽

Ernesto Torsiello ◽

Filippo Spiezia ◽

Francesco Oliva ◽

...

Keyword(s):

Blood Loss ◽

Bone Graft ◽

Bone Grafting ◽

Orthopaedic Surgery ◽

Donor Site ◽

Autologous Bone Graft ◽

Iliac Crest Bone Graft ◽

Alternative Source ◽

Autologous Bone Grafting ◽

Autologous Bone

Autologous bone grafting is common in trauma and orthopaedic surgery. Both the Reamer Irrigator Aspirator (RIA) and Iliac Crest Bone Graft (ICBG) aim to obtain autologous bone graft. Although the process of harvesting a bone graft is considered simple, complications may occur. This study examined morbidity and pain at the donor site, blood loss, and iatrogenic fractures, comparing RIA and ICBG. The source of the autologous bone graft, the alternative graft sites, and the storage modalities of the harvested bone marrow were also evaluated. In May 2021, PubMed, Embase, Scopus, and Google Scholar were accessed, with no time constraints. RIA may produce greater blood loss, but with less morbidity and complications, making it a potential alternative source of bone grafting.

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Calvarial bone grafts to augment the alveolar process in partially dentate patients: a prospective case series

International Journal of Implant Dentistry ◽

10.1186/s40729-020-00251-5 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Ahmed Yousif ◽

Gerry M. Raghoebar ◽

Thomas F. Putters ◽

Arjan Vissink ◽

Jurjen Schortinghuis

Keyword(s):

Bone Grafting ◽

Donor Site ◽

Case Series ◽

Wound Dehiscence ◽

Bone Grafts ◽

Healing Time ◽

Bony Defect ◽

Alveolar Process ◽

Calvarial Bone ◽

Partially Dentate

Abstract Background Calvarial bone grafts as a pre-implant augmentation procedure are mostly used to reconstruct the edentulous maxilla, although calvarial grafts could also be used in the partially dentate patients needing extensive bone grafting. Methods In 7 consecutive partially dentate patients needing bone grafting because of a large bony defect as a result of trauma (n = 1), oligodontia (n = 1), failed previous bone augmentation (n = 1), or atrophy (n = 4), the alveolar process was reconstructed with calvarial bone as a pre-implant procedure. Results A total of 30 implants was placed either immediate at the time of bone grafting (13 implants) or after a healing time of 4 months when immediate placement was not possible (17 implants). One wound dehiscence occurred that needed secondary intervention. During follow-up (40 ± 14 months), one implant was lost due to peri-implantitis with an infected osteosynthesis screw. Marginal peri-implant bone loss was 0.65 ± 0.47 mm during this period. Conclusion Calvarial bone is a sound extra-oral donor site when aiming for reconstruction of a large bony defect of the alveolar process of partially dentate patients.

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Autologous Calvarial Bone Remodeling Technique for Small to Medium-Sized Cranial Defects in Young Children: The “Switch-Cranioplasty” Technique

Pediatric Neurosurgery ◽

10.1159/000511330 ◽

2021 ◽

pp. 1-6

Author(s):

Sonal Jain ◽

Shelly Wang ◽

Carolina Sandoval-Garcia ◽

George M. Ibrahim ◽

Walker L. Robinson ◽

...

Keyword(s):

Bone Growth ◽

Autologous Bone Graft ◽

Dural Defect ◽

Skull Defect ◽

Calvarial Bone ◽

Leptomeningeal Cyst ◽

Case Presentation ◽

Skull Defects ◽

Calvarial Defects ◽

Autologous Bone

Introduction: Reconstruction of cranial defects in children less than 2 years of age, particularly when there is an associated dural defect, is challenging due to the need to accommodate active skull growth, limited options for autologous bone graft and thin calvarial bones. We use a simple remodeling technique that exploits the normal dura’s inherent potential for new bone growth while covering the dural defect with adjacent skull. Case Presentation: We describe an alternating, two-piece craniotomy or “switch-cranioplasty technique” to repair an occipital meningocele. The two pieces of craniotomy bone flap created around the existing skull and dural defect are switched in the horizontal plane in order to cover the site of the defect and the abnormal dura of the meningocele closure. The area of the original skull defect is transposed laterally over the normal dura. The healing of the lateral skull defects is facilitated with autologous bone chips and dust and covered by periosteal flaps that stimulate spontaneous re-ossification. Discussion: The advantages of this technique are the use of autologous bone adjacent to the skull defect, incorporation of the autologous bone into the growing skull, an acceptable cosmetic and functional outcome in a simple manner. The indications can be extended to include small to medium-sized calvarial defects secondary to leptomeningeal cyst and trauma.

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Re-operation rate after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02282-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Daniel Körner ◽

Christoph E. Gonser ◽

Stefan Döbele ◽

Christian Konrads ◽

Fabian Springer ◽

...

Keyword(s):

Surgical Treatment ◽

Bone Grafting ◽

Cartilage Damage ◽

Osteochondral Lesions ◽

Retrograde Drilling ◽

Autologous Bone Grafting ◽

Operation Rate ◽

Group A ◽

Autologous Bone ◽

Group B

Abstract Background The aim of this study is to analyse the re-operation rate after surgical treatment of osteochondral lesions of the talus (OCLTs) in children and adolescents. Methods Between 2009 and 2019, 27 consecutive patients with a solitary OCLT (10 male, 17 female; mean age 16.9 ± 2.2 years; 8 idiopathic vs. 19 traumatic) received primary operative treatment (arthroscopy + bone marrow stimulation [BMS], n = 8; arthroscopy + retrograde drilling, n = 8; autologous chondrocyte implantation [ACI]/autologous bone grafting, n = 9; arthroscopy + BMS + retrograde drilling; n = 1; flake fixation, n = 1). Seventeen OCLTs were located at the medial and ten at the lateral talus. ‘Re-operation’ as the outcome measure was evaluated after a median follow-up of 42 months (range 6–117 months). Patients were further subdivided into groups A (re-operation, n = 7) and B (no re-operation, n = 20). Groups A and B were compared with respect to epidemiological, lesion- and therapy-related variables. Results Seven of 27 patients needed a re-operation (re-operation rate 25.9% after a median interval of 31 months [range 13–61 months]). The following operative techniques were initially used in these seven patients: arthroscopy + BMS n = 2, arthroscopy + retrograde drilling n = 4, ACI + autologous bone grafting n = 1. A comparison of group A with group B revealed different OCLT characteristics between both groups. The intraoperative findings according to the International Cartilage Repair Society (ICRS) classification revealed significantly more advanced cartilage damage in group B than in group A (p = 0.001). Conclusions We detected a re-operation rate of 25.9% after primary surgical OCLT treatment. Patients with re-operation had significantly lower ICRS classification stages compared to patients without re-operation.

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