The use of vascularized cranial bone in reconstruction of the maxilla and mandible

Defects of the maxilla and mandible can cause significant functional and ae sthetic problems for patients. Vascularized calvarium was used to reconstru ct six mandible and four maxillary defects between 1991 and 1998. The ages of patients ranged from 15 to 68 years. Full thickness calvarial bone was p referred for the repair of segmental mandibular defects but split thickness calvarial bone onlay was used to reconstruct contour deformities. When ful l thickness calvarial bone was used, the donor site defect was covered with split thickness cranial bone. In small defects, a bipedicled galea pericra nial flap was used for reconstruction. The bone was supplied by the superfi cial temporal vessels in all cases. A tunnel in the subcutaneous plane was used for the flap transfer to avoid facial nerve branches. Immediate expans ion was performed during the preparation of the tunnel to prevent pedicle c ompression. Bone vascularization was checked with bone scan and serial X-ra ys and clinical examinations were also performed in the postoperative perio d. Flap necrosis was observed in one case, satisfactory functional and aest hetic results were achieved in all other patients. Vascularized cranial bon e has not only the same structural features as facial bones but also a reli able vascular supply. The superficial temporal fascia and hairy skin may be included in the cranial bone flap to treat complex defects. The donor site scar is well hidden in the scalp. There is minimal donor site discomfort. In conclusion, vascularized cranial bone is a good method of treatment in s elected cases.