**2. Reconstruction of the mandible after radical tumor surgery and post-traumatic missile injuries as secondary phase**

We had a long experience in reconstruction of half of the lower jaw by free bone graft from iliac crest as autograft, and the type of graft which has been used was cortical-cancellous bone graft as a block from iliac crest. We can reshape the graft according to the required defect. The graft was chosen because its rigidity gave the contour of the mandible, which is 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.

for reconstruction of the temporomandibular joint (TMJ) by chondro-osseous graft in TMJ

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

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

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 clini-

**6.** Reconstruction of the temporomandibular joint (TMJ) by Kummoona chondro-osseous

We had a long experience in reconstruction of half of the lower jaw by free bone graft from iliac crest as autograft, and the type of graft which has been used was cortical-cancellous bone graft as a block from iliac crest. We can reshape the graft according to the required defect. The graft was chosen because its rigidity gave the contour of the mandible, which is

**2.** Reconstruction of the mandible and maxilla after missile war injuries of the face.

**2. Reconstruction of the mandible after radical tumor surgery and** 

should be biocompatible substances with similar mechanical properties to bone.

disease and hemifacial microsomia facial deformities.

4 Bone Grafting - Recent Advances with Special References to Cranio-Maxillofacial Surgery

grafting occurred during the last 4–5 decades.

**1.** Reconstruction of the mandible after radical tumor surgery.

**4.** Reconstruction of the frontal bone and anterior cranial fossa.

**post-traumatic missile injuries as secondary phase**

**5.** Reconstruction of receded chin by sandwich technique.

**3.** Reconstruction of the orbital floor with large traumatic bony defect.

cal cases:

graft.

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.
