Reconstruction of bone and soft tissue in extensive facial defects

Autogenous iliac and rib grafts are used for the reconstruction of the maxilla and the mandible. Immobilization is assured by use of internal rigid fixation with reconstruction plates or lag screws; in the maxilla, miniplates may be used as well. An immediate reconstruction of chin defects is undertaken with a rib graft. For other defects of the mandible and maxilla, secondary reconstruction via an extraoral approach, without incision of the oral mucosa, is recommended to reduce the danger of infection as much as possible. Defects in facial soft tissue must be closed with local or distant flaps before bone transplantation is begun.