Maxillary augmentation with a microvascularly anastomosed fibula: a preliminary report

The high resorption rate of nonvascularized bone grafts can be appreciably slowed with the use of endosseous implants and implant-supported prostheses. In cases of extreme atrophy, graft fixation with implants is hardly possible. Especially in the presence of compromised overlying soft tissues, the consolidation of such a graft can also present problems. Improved results can be obtained through use of revascularized bone grafts. Such a method using an anastomosed fibula graft to augment the maxilla is illustrated by a clinical case. After harvesting the graft, the side to come into contact with the alveolar crest is denuded of periosteum, and cuneiform ostectomies are made into the graft to facilitate its adaptation to the maxillary arch. The graft is anastomosed to the facial vessels through an intraoral route and can be placed in such a way as to simultaneously correct any existing crossbite. In contrast to an iliac graft, the implants can be placed bicortically in a fibular graft.