Oculoplastic uses of cranial bone grafts

Cranial bone grafting for craniofacial reconstruction has gained wide acceptance in recent years and is being used with increasing frequency by ophthalmic plastic surgeons. Alloplastic materials (particularly newer materials such as porous polyethylene, hydroxyapatite, and rigidly fixated metal alloys) have a clear role in orbital reconstruction, and in many oculoplastic applications are the material of choice. However, in certain applications cranial bone grafts may be superior, eg, in managing large posttraumatic or postsurgical orbital defects or orbito-sinus defects in the milieu of chronic sinusitis. We describe our current techniques for harvesting full-thickness outer-table grafts and split-thickness periosteally-bound "fish-scale" grafts. Harvesting cranial bone grafts is not without risk and donor site morbidity, and we do not advocate the use of cranial bone grafts in those cases that might be managed as well (or better) with alloplastic material. At the same time, ophthalmic surgeons involved in orbital reconstruction should be familiar with the indications for bone grafts and comfortable with harvesting techniques so that they are not limited when circumstances warrant the use of autogenous material.