Zygomatic arch reconstruction with autogenous rib bone graft in a post irradiated patient -- a case report

Reconstruction of zygomatic arch using an autogenous free non-vascularised bone graft is presented. The zygomatic arch was resected along with the masseter and part of temporalis muscle following a histologically diagnosed case of chondrosarcoma. She received radiotherapy 3 weeks post-operatively to the site. The resultant facial asymmetry was unacceptable to the patient. She was therefore rescheduled for reconstruction of the zygomatic arch despite the anticipated attendant risk of avascular bed for the graft. Bone grafting was done 44 months post irradiation and the patient had been followed up for 38 months without evidence of rejection. We evaluated other sites of possible bone of similar contour and thickness to the zygomatic arch; we found the rib most suitable, despite the poor quality of rib as graft material, because it is a dense, thick bicortical bone with low proportion of cancellous bone, although it is the second most favoured donor site for free bone graft. The advantages of the rib as a graft are that it presents a contour that could be shaped to fit many defects, it is available in sufficient length up to 12-18 cm to fit large defects, the donor site regenerates when the periosteum is preserved.