If there is a question regarding the integrity of the skull, a bone window CT scan should be obtained.In the balding patient or patient at risk for male pattern baldness, an incision approximately 3 cm medial to the palpable temporal line paralleling the squamosal suture centered behind the ear will provide access to the parietal bone in an area which will be hidden despite hair loss.If a coronal flap is planned, it provides access for harvesting of the bone grafts.The bone thickness of the skull stops increasing by the age of 20 years. The majority of bone grafts are harvested from the outer table. The skull in an adult consists of an inner and outer table of membranous bone separated by a diploe space.In general, grafts should also not be harvested from the area of suture lines that may be somewhat thinner than the surrounding bone and have a poorly-defined diploe space.Two danger areas to be avoided are the midline over the sagittal sinus and the area lateral to the temporal line that may be quite thin.Of these bones, the parietal bone consistently has the greatest thickness and should be the first choice as a harvest site. The skull is comprised of the paired parietal and temporal bones and the single frontal and occipital bones.This type of bone demonstrates less resorption compared to bone from other sources. The skull is composed of membranous bone.This should be considered in preoperative planning. In patients who have had numerous reconstructive procedures requiring bone grafts, it may be difficult to locate a safe area from which to harvest further grafts.Outer table bone graft harvest may not be safe in young children due to the thinness of the skull and poorly-developed diploe space.Calvarial bone grafts serve as an excellent means of recontouring the nasal and periorbital areas where bony definition and acute angles require sturdy and precisely-shaped bone grafts. Bone grafts are used for a variety of purposes in facial skeletal surgery including trauma, oncologic, and congenital reconstructive cases.Return to: Reconstructive Procedures Protocols GENERAL CONSIDERATIONS See also: Case Example Calvarial Bone Graft Harvest
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