Maxillary augmentation with a microvascularly anastomosed fibula: a preliminary report

Area of Science:

• Oral and Maxillofacial Surgery
• Regenerative Medicine
• Biomaterials Science

Background:

• Nonvascularized bone grafts exhibit high resorption rates, limiting their efficacy in severe maxillary atrophy.
• Fixation with endosseous implants can be challenging in cases of extreme atrophy and compromised soft tissues.
• Revascularized bone grafts present a promising alternative for enhanced graft survival and integration.

Purpose of the Study:

• To illustrate a clinical case of maxillary augmentation using an anastomosed fibula graft.
• To demonstrate a surgical technique for adapting and securing a fibula graft within the maxilla.
• To highlight the advantages of revascularized fibula grafts over traditional iliac grafts for maxillary reconstruction.

Main Methods:

• Harvesting a fibula graft and preparing it for maxillary adaptation, including periosteum removal and cuneiform ostectomies.
• Anastomosing the fibula graft to facial vessels via an intraoral approach.
• Simultaneous correction of crossbite during graft placement.
• Placement of bicortical implants into the fibula graft.

Main Results:

• The revascularized fibula graft facilitated successful maxillary augmentation.
• The technique allowed for precise adaptation of the graft to the maxillary arch.
• Simultaneous correction of crossbite was achieved.
• Bicortical implant placement in the fibula graft was feasible, enhancing stability.

Conclusions:

• Anastomosed fibula grafts are a viable and effective option for maxillary augmentation, especially in cases of severe atrophy.
• This technique offers improved graft survival, stability, and functional outcomes compared to nonvascularized grafts.
• The ability to place bicortical implants provides superior fixation for implant-supported prostheses.