Cranial bone grafting in maxillofacial trauma and reconstruction

Although manipulation of cranial bone has a long history, the use of cranial bone for reconstruction of craniomaxillofacial defects has only become popular in the last 15 years. Many refinements in harvesting and placement techniques have occurred over that time period. Cranial bone is valued for craniofacial skeletal reconstruction because of the proximity of the donor site to the recipient site, reasonable resistance to resorbtion, suitable geometry, and ability to be rigidly fixated. Although intracranial injury is a possibility, careful harvesting techniques minimize donor site morbidity. A detailed knowledge of the anatomy of the tissues around the skull is critical to safe harvesting of cranial bone grafts. Selection of appropriate graft types, proper handling techniques, and use of rigid fixation when indicated result in reliable reconstruction and augmentation of the craniofacial skeleton.