The Role of Primary Bone Grafting in Complex Craniomaxillofacial Trauma

TLDR

Complex facial injuries are best managed by direct exposure, reduction, and fixation of all fractures using interfragmentary wiring. The study aims to correct all deformities during the initial operation whenever possible. The authors treated 401 patients with complex facial injuries, performing 241 primary bone and cartilage grafts in 66 patients, using immediate grafting for comminuted bone and rigid internal fixation with the A‑O technique for mandibular fractures. Immediate bone grafting yields excellent results with rare complications and prevents severe postoperative deformity and disability that would be difficult to correct later.

Abstract

The role of craniofacial surgical techniques and immediate bone grafting in the management of complex craniofacial trauma has been reviewed. Four hundred and one patients with complex facial injuries have been treated. Two hundred and forty-one primary bone and cartilage grafts have been performed in 66 patients. Complex facial injuries should be managed by direct exposure, reduction, and fixation of all fractures utilizing interfragmentary wiring. Very comminuted or absent bone is replaced by immediate bone grafting, producing a stable skeleton without the need for external fixation devices. Associated mandibular fractures are managed with rigid internal fixation utilizing A-O technique. Results of immediate bone grafting have been excellent, and complications are rare. All deformities should be corrected, whenever possible, during the initial operation. This one-stage reconstruction of even the most complex facial injuries will prevent severe postoperative traumatic deformity and disability that may be extremely difficult or impossible to correct secondarily.