[Use of the trephine for harvesting bone from the iliac crest]

For closure of the cleft alveolus usually a choice between a bone graft from the chin or from the iliac crest is made. In the department of Oral and Maxillofacial Surgery of the University Hospital Groningen harvesting of bone from the iliac crest was performed with an open technique. From the results of an earlier study on the morbidity of this procedure until June 1997 it was found that in 26.1% of the cases a contour defect could be observed in the donor region. The mean width of the mature scar was 5.0 +/- 2.4 mm (range 1-10 mm). Especially these findings and the wish to further reduce postoperative pain led the University Hospital to start harvesting iliac crest bone grafts with a trephine in june 1997. In the period june 1997 through december 1999 iliac crest bone grafts were harvested in 28 cleft lip and palate patients (mean age 10.5 years; range 8-12 years) with this trephine technique. The scars were smaller in +/- 0.3 both length (mean 15 +/- 1.5 mm; range 11-24 mm) and width (mean 1.5 +/- 0.3 mm; range 1-3.5 mm). No contour defects and sensory loss occurred. Postoperative pain could adequately be relieved by local infiltration of the donor area with a 0.25% marcaïne solution and analgetics. On the first day post surgery all patients could be mobilised without problems. Based on these findings and recent literature it can be concluded that the use of the trephine is the method of choice for harvesting iliac crest bone in cleft lip and palate patients. Only when large amounts of bone, a bone block or a piece of cortical bone is needed, the open technique should be used.