Cranial bone grafts for post-traumatic facial defects

Recent interest in onlay cranial bone grafts has shown it to be a preferred technique in the reconstruction of facial defects. This paper reports seven patients in whom outer table cranial bone grafts were used to reconstruct post-traumatic facial deformities. These included orbital and zygomatic deformities (2 patients), maxillary defects (2 patients), mandibular defects (2 patients), and nasal deformity (1 patient). A brief review of the development of membranous bone grafting for maxillofacial reconstruction is given. Good cosmetic results were obtained in six of seven patients with no evidence of graft resorption. One patient required removal of the graft because of inadequate soft tissue coverage. No patient suffered any significant donor site morbidity. In summary, this technique is extremely useful in treating post-traumatic bony deformities of the facial skeleton. The excellent graft survival and ease in harvesting the graft make this technique preferable to traditional endochondral grafts taken from the iliac crest and rib.