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Between years 1996 and 1997, pedunculated parietal bone graft for facial reconstruction after tumor excision was used in 8 patients. The defects comprised one side of maxilla with the orbit bottom, zygomatic bone and the orbit bottom, mandibular ramus, and the whole mandible: in 4, 1, 2, and 1 patient respectively. The reconstruction was done directly after tumor excision in 6 patients and later on in the other 2. The grafts were of full thickness in 6 and of outer table in 2. Functional and cosmetic effects were considered satisfactory in 6 patients. The whole mandible reconstruction ended up with a failure due to infection and tumor recurrence.

The embryologic origin of the parietal bone is membranous bone. Experimentally, membranous bone grafts, maintain its original size, structure with good osteo-integration contrary to endochondral bone autografted (ilium, rib or tibia). The morbidity of skull bone grafts is much less than other donor site of bone. In our study, between 1988 and 1992, autogenous split calvarial bone grafts were used in maxillo-facial reconstruction of seventy-one patients. We observed no major complication. Patient followup has been from 2 to 6 years and results are better than endochondral grafts (iliac crest, ribs, tibia). Parietal grafts bone have been used in the following case: nasal reconstruction, rehabilitation of defects in the floor of the orbit, maxilla grafts, correction of frontal depression and mandibular reconstruction.

The clinical and radiographic results of 9 consecutive vascularized full-thickness cranial bone grafts to the midface are examined for a period of 3 to 8 years. Satisfactory contour was maintained throughout the follow-up in 5 patients with severe congenital facial deformities. Axial computerized tomography revealed complete survival of a trilaminar bone graft in each case. The complications were limited to a small area of alopecia in the midportion of one temporal scar. This relatively tedious harvest of bone is indicated for severe congenital malar and maxillary midface hypoplasia beginning at 4 years of age.

The authors report the advantages and disadvantages of the calvarial bone used as bone graft in the maxillofacial area. They review most of the parietal bone's indications and report their experience with clinical cases.

Reconstruction of bony structures of the face is always a problem as big as the defect and the function that must be replaced. Everything from simple grafts to sophisticated distant bone flaps has been used. Based on the studies of Cutting et al., Psillakis et al., and Casanova et al., we have developed the full-thickness galeoparietal bone flap, initially for mandibular reconstruction, but of great use for all maxillofacial reconstructions. From July of 1987 to December of 1988, 14 patients have been operated on. The experience with this flap is shown in four patients as follows: primary reconstruction of a mandible as a result of ameloblastoma, secondary reconstruction of a mandible with associated old fractures and malalignment of segments, bilateral malar reconstruction in a patient with Treacher Collins syndrome, and severe sequelae of an already treated Romberg case. Small variations could be made to best accommodate the technique used to the defect we were treating. Some technical details, the experience, the results, and possible sequelae or complications are also discussed.

Experience with thirty-seven patients demonstrating the versatility of the split calvarial graft in facial reconstruction is presented. A total of sixty grafts have been used with no evidence of significant clinical reabsorption, infection, or extrusion; advantages and limitations are discussed. We conclude that the split calvarium represents a readily available and reliable source of membraneous bone for grafting maxillofacial defects with minimal limitations and low morbidity.

Bony defects of the face continue to challenge the reconstructive surgeon. Traditional sources of autologous bone from the rib or pelvis have been associated with the limitations of pain at the donor site, the need for a second operative field, variable "take" of the graft with poor eventual survival and, ultimately, less than optimal reconstruction. Calvarial bone grafting provides a readily accessible source of bone from an inconspicuous donor site, usually within the same operative field. The morbidity is minimal. The calvarial bone graft is especially useful in repair of the frontal sinus, orbital floor, nasal and malar regions, as well as in certain instances of cleft palate with alveolar involvement.