[Parietal grafts in maxillofacial and pre-implant surgery]

Due to the recent regulations generated by the diversity of infectious risks, autologous bone is the standard graft material in maxillofacial surgery. Although synthetic biomaterials can be useful, they remain insufficient in many situations. Among the many sites offering graft material, monocortical parietal bone which is accessible within the craniocephalic operative field has distinguishing characteristics due to its membranous embryological origin and its mode of direct ossification which does not include a cartilaginous stage. The proportion of cancellous bone per unit volume is much higher than in enchondral bone (iliac bone, ribs...). These factors are undoubtedly the source of its main qualities--very little resorption and excellent capacity for bony integration--motivating its increasingly widespread use over the past twenty years. We present our experience in a series of patients who underwent surgery between 1992 and 1997. Parietal bone was used for orthognathic, pre-implant or reconstruction surgery after trauma or carcinological trauma. We present a description of the surgical procedures together with morbidity results and compare our findings with those found in large series in the literature, particularly concerning rare neuromeningeal complications. We discuss indications for parietal grafts and their course at the receiver site.