Craniofacial Anomalies, Part 2 - Plastic Surgery Internal

lengthening was 16.8mm in the mandible and
14.5mm in the midface.
Other complications of craniofacial distraction
osteogenesis are tabulated in Table 8. 521
AUGMENTATION AND CONTOURING PROCEDURES
There are many indications for autogenous bone
grafts in craniofacial surgery. 522 Most craniofacial
surgeons believe that autogenous grafts of bone or
cartilage are the materials of choice in craniofacial
reconstruction because of their resistance to infection
and low morbidity compared with alloplastic
implants. 523 For an in-depth review of the subject,
the reader is referred to Selected Readings in Plastic
Surgery volume 10, number 2. 524
The calvarium is usually the preferred source of
donor autogenous bone for grafting in the craniofacial
skeleton. 79,80,525,526 Cutting 525 delineated the vascular
supply to the cranium and introduced the concept
of using vascularized calvarial bone in craniofa-
TABLE 8
Complication Rates
SRPS Volume 10, Number 17, Part 2
cial procedures. He determined that the most
important source of perfusion to the cranium is the
middle meningeal artery, which of course is not useful
as a pedicle for bone transfer. Branches of the
anterior and posterior deep temporal arteries, which
also supply the temporalis muscle, constitute a lesser
vascular supply to the cranium. Finally there is the
vascular plexus fed by the supraorbital, supratrochlear,
superficial temporal, and occipital arteries. The
temporoparietalis fascia (superficial temporal fascia)
contains the superficial temporal artery and provides
a clinically useful pedicle to support a vascularized
calvarial bone graft. 525,527
McCarthy and colleagues 79,80 suggest leaving the
galea and overlying vascular network broadly
attached to the bone when transferring a vascularized
calvarium bone flap because of the poor vascular
connections within the periosteum.
A review of vascularized calvarial inlay grafts based
on a temporalis myoosseous design 528 notes preservation
of the growth potential and a patent suture.
(Reprinted with permission from Mofid MM, Manson PN, Robertson BC, et al: Craniofacial distraction osteogenesis: a review of 3278
cases. Plast Reconstr Surg 108:1103, 2001.)
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