**1. Introduction**

Bone grafting is not a new technique but has a longer history, and its important component in modern surgery begins nearly before three-and-a-half centuries.

The construction of first modern microscope by Galileo Galilei (1609) and the discovery of blood circulation by William Harvey in 1615, the first bone grafting operation was performed by a Dutch doctor in 1668, Jacob Van Meekeren. This doctor placed a piece of dog bone in a soldier's skull defect from war injury to heal in, but unfortunately, the soldier was often excommunicated by the church for being part dog, and he was pressing. The soldier did request his doctor to remove it because its presence upsets him, and the doctor discovered of how well bone grafting actually worked [1].

In the process of attempting to remove the bone graft, Van Meekeren discovered that the bone had healed too well, and he found it's actually irremovable. It was the first xenograft applied on humans. More than 150 years later, the first recorded allograft operation was performed by Dr. Walter in Germany. Later, Great British surgeon Sir William Macewen (1880) [2] (from Lexer) attempted the transplantation of bone by reconstruction of a diaphysis of a child's humerus arm from the leg of another patient and considered this as real success in bone allograft transplantation [1].

Bone grafting is an interesting topic practiced by cranial-maxillofacial surgeons and orthopedic surgeons for restoring continuity of bone after radical tumor surgery, road traffic accident with loss of bone segments, and in the cases of post-traumatic missile war injuries. Bone grafting has been used for reconstruction of congenital cranial and facial deformities and

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

for reconstruction of the temporomandibular joint (TMJ) by chondro-osseous graft in TMJ disease and hemifacial microsomia facial deformities.

highly vascular and applied with firm and rigid fixation. We used previously intermaxillary fixation (IMF) for the healing process for a period of 6 weeks, but nowadays, we change our technique by using rigid fixation without IMF, and we ask our patient to start functioning the jaw immediately with semifluid diet, based on Moss theory (the growth of bones is based on the functional demand of periosteal matrix of the facial skeleton) [4]. We noticed long fixation by IMF end with difficulty of mouth opening and spasm of muscles with damage to TMJ.

Introductory Chapter: Bone Grafting and Its Application in Cranial-Maxillofacial Surgery…

http://dx.doi.org/10.5772/intechopen.80299

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In children we do use rib graft for reconstruction of the lower jaw after tumor surgery. We face slight difficulties in manipulating the rib graft due to rigidity and mainly cortical type, and the amount of cancellous bone is very little, and also the rib is less vascular and less minable for cortical-cancellous bone graft from iliac crest with possibilities of pleural perforation.

Bone grafting been used for reconstruction of the mandible after radical excision of tumor surgery, and half of the mandible can be reconstructed by free bone graft from the iliac crest of corticalcancellous type as one piece or two pieces with rigid fixation is required and IMF is not necessarily used, but mobilization of the jaw was required after few days for restoration of growth and function of the graft and the mandible. In some cases, the tumor involves half of the mandible, the body, and the ascending ramus, but without involving the condylar and subcondylar region, the tumor was resected at the level of subcondylar region, and the preserved condyle was fixed to the bone graft after reshaping the graft. The condyle with the graft was reimplanted in the glenoid fossa after firm rigid fixation through bone grafting. A series of cases were managed by the author by using this technique. We reported that tumor cases of cystic ameloblastoma do not involve the inner cortical plate, but the tumor involves the outer cortical plate and the cancellous bone. The outer cortical plate excised and the cancellous bone that involved by the tumor. The inferior dental nerve was preserved after complete excision of the tumor and decortication of the bed, and a piece of cortical-cancellous bone graft was used for reconstruction of the defect [5, 6]. We reported failure of the graft in two cases. In the first case, the area was subjected to deep

X-ray therapy and the other to chemotherapy during the healing period.

followed by reconstruction of the bone defect by bone graft from iliac crest.

**post-traumatic missile injuries**

**3. Reconstruction of the mandible and maxilla as secondary phase of** 

Bone grafting has been used for reconstruction of the mandible as secondary phase of missile war injuries. Sometimes, the situation is more complicated and requires flap surgery; our choice is the Kummoona lateral cervical flap [6] which has been used for the reconstruction of submental area previously subjected to high-velocity bullet injuries with a lot of scars in the submental area, and the lower lip was retracted down by scar with loss of mouth seal. The scar was excised, and the lateral cervical flap was used before 3 months of bone grafting

Bone grafting was done successfully for the reconstruction of defect and deformity of the maxilla by shell injuries. Previously, the area was explored and reconstructed by using bone graft from the iliac crest as cortical-cancellous bone after measuring and reshaping it. The margins of bony defect were decorticated, and the graft was successfully fixed with 0.25 mm

of soft stainless steel wire; the aim was to restore the esthetic and function of the face.

Bone grafting is a surgical technique used to fix problems by using transplanted bone to repair, rebuild, and replace missing bones in order to repair bone fracture or to replace missing bone after tumor surgery and loss of bone in trauma injury in road traffic accident and in post-traumatic missile war injuries and has also been used for reconstruction of damaged joints [3]. It is extremely a complex technique which poses a significant health risk to the patient and its liability to fail.

Bone graft was used as filler and scaffold to facilitate bone formation and generally has the ability to regenerate completely but requires a very small fracture space or scaffold to do so [3].

Bone graft may be autologous bone as cancellous or cortical or cortical-cancellous types harvested from iliac crest or from rib. Allograft a cadaveric type of bone usually obtained from bone bank or as synthetic bone made of hydroxyapatite or other naturally occurring and should be biocompatible substances with similar mechanical properties to bone.

Bone grafting is possible because bone tissue has the ability to regenerate completely once the space is provided into which it has to grow as natural bone. Bone grafting or transplantation of bone tissue is beneficial in fixing bones that have been damaged or destroyed by war or required for building bone around transplanted tooth in dental surgery. Bone grafting is a technique which requires great experience, skill, and knowledge, and great advances of bone grafting occurred during the last 4–5 decades.

Many techniques were advocated and described for reconstruction of discontinuity defect of craniofacial regions after tumor surgery or congenital deformities or traumatic injuries. Bone graft is widely used and considered as the second tissue transplantation after blood transfusion.

We successfully applied bone grafting in cranial-maxillofacial surgery in the following clinical cases:

