The use of a subperiosteal tissue expander in rib reconstruction of an atrophic mandible.

A technique is described that provides adequate coverage for rib grafts used in reconstruction of the atrophic mandible. The flaps are highly vascular and thick because of the fibrous capsule that forms around the tissue expander. A one-stage expansion technique is used that reduces the total time needed for reconstruction.

The use of freeze-dried rib and hydroxylapatite in the treatment of a fracture occurring in a patient with familial facial osteodystrophy.

The treatment of repeated pathologic fractures of the mandible has long taxed the ingenuity of surgeons. The complexity of the problem increases with the recognition of a metabolic defect that renders the facial bones hypoplastic. In the case presented, a tentative diagnosis of familial facial osteodystrophy was made at the National Institutes of Health. Since that time, the patient has undergone autogenous onlay grafting, which has completely resorbed. Because of continuous resorption, a number of pathologic fractures have occurred. The most recent fracture was treated by means of a freeze-dried rib, which acted as a floor and as a splint to the fracture site. Hydroxylapatite and a marrow mixture were placed on the floor to gain height, strength, and durability. Subsequently, hydroxylapatite augmentation was performed to gain a more anatomic alveolar ridge. The patient's 12-month follow-up has shown the mandible to be intact with no noticeable change in either vertical or horizontal dimensions.