Cancellous Bone Volume and Complications with Proximal Tibia Graft Donor in Maxillofacial Surgery

Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity and augmentation of sinus maxillary. Bone graft can be harvest from iliac bone, calvarium, tibial bone, rib and intraoral bone. Proximal tibia is a common donor site with few reported problems compared to iliac crest. The aim of this study was to quantify the volume of cancellous graft harvested by a lateral approach from proximal tibia and to assess the complications of this technique. 29 patients, 16 women and 13 men (mean age 35 years, range 19–64), was referred to the department of oral and maxillofacial surgery at Federal Hospital of State Servers. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathologies and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia for graft removal from Gerdy’s tubercle under general anesthesia. Two of these patients had removal bone graft from both tubercules (bilateral). The mean volume of bone harvested was 31.0±2.8 mL for bilateral removing graft and 12.5±3.8 mL for unilateral removing (range 8.0-33.0 mL).  Only four patients (13.8 %) had minor complications, which included superficial infection, pain, suture dehiscence and unwanted scar. Nevertheless, none of these complications decrease the final result and resolved completely.We conclude that lateral approach to removal tibial bone graft is safe, speed, easy and provides sufficient volume for procedures in oral maxillofacial surgery region with minimal postoperative morbidity.

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Vittayakittipong, P., W. Nurit, et al. (2012). "Proximal tibial bone graft: the volume of cancellous bone, and strength of decancellated tibias by the medial approach." Int J Oral Maxillofac Surg 41(4): 531-6.