The posterior ilium as a donor site for maxillo-facial bone grafting

The anterior iliac crest has been the traditional source of pelvic bone for autogenous bone grafting in the maxillo-facial skeleton. Although the posterior iliac crest is frequently utilized by our orthopaedic colleagues, little attention has been given this site in the oral and maxillo-facial literature. As the posterior crest affords an almost unlimited amount of bone for autogenous grafting in the maxillo-facial region, we feel its use is indicated when very large amounts of bone are required. The techniques for removal of cancellous and cortico-cancellous posterior crest grafts are described in detail. Morbidity of the posterior crest donor site includes possible difficulties with patient positioning, injury to the sacro-iliac joint, injury to the sciatic or cluneal nerves, and severe haemorrhage. Ambulation following the use of the posterior crest has not been a problem. Significant blood loss can be adequately controlled with proper exposure, electrocautery, and bone wax.