Midfacial Reconstruction Using Calvarial Split Bone Grafts | Facial Plastic Surgery | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Article
February 2005

Midfacial Reconstruction Using Calvarial Split Bone Grafts

Arch Otolaryngol Head Neck Surg. 2005;131(2):131-136. doi:10.1001/archotol.131.2.131

Objective  To evaluate the success rate of free calvarial grafts for midfacial reconstruction, the relevance of soft tissue coverage, and the influence of radiotherapy.

Design  Retrospective analysis.

Setting  University medical center.

Patients  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.

Interventions  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.