The use of freeze-dried bone in middle-third face advancements

A considerable quantity of bone is required for grafting in most middle-third face advancements. In many patients, especially children, the additional surgery needed to obtain large quantities of autogenous bone adds considerable time and morbidity to the primary operative procedure. During the past 3 years we have utilized freeze-dried bone allografts processed by the Tissue Bank, Naval Medical Research Institute, Bethesda, Maryland. Eighteen patients undergoing various types of middle-third face advancement have received allografts and have been followed closely for at least 12 months postoperatively. Although the duration of follow-up is limited, the results to date have been encouraging. Osteotomies in all eighteen patients healed. Nine of the eighteen patients studied had no complications and healed uneventfully. Four patients developed infections postoperatively, necessitating partial removal of the graft material, and all subsequently healed without further difficulty. Four patients had intraoral exposure of the grafts postoperatively--three in the pterygoid maxillary area and one in the palate. However, no clinical infections developed in these patients and the exposed grafts healed uneventfully. One patient extruded a small sequestrum of bone, without infection, 2 years postoperatively.