To Graft or Not to GRAFT - What is the answer....

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#1 Post by **rosy22** » Mon Apr 28, 2008 1:55 pm

I am receiving conflicting opinions (what else is new ) about grafting. Is it always necessary? What this latest OS is proposing is a segmented ( 3 piece) LeFort. He says he does not use grafting but will use her own bone in the area in which they cut. Was wondering what others had been advised. In my DD case this would be for upper - forward and up, lower forward.

#2 Post by **ohmyjaw** » Mon Apr 28, 2008 2:57 pm

I had a three-piece lefort and had a bone graft from my hip. I don't think it is always necessary; it just depends on what you're having done. I would leave it up to the surgeon - if he/she feels it's necessary; it probably is.

#3 Post by **Arvensis** » Mon Apr 28, 2008 4:36 pm

I suspect bone grafts are related to 1) surface area between moved areas, IE if moving too far forward and need a larger base than the existing bone provides and 2) age at surgery, IE concerns about growth time?

I had a three piece Lefort, no bone graft, and they moved my upper forward 6 mm. They moved the upper front section down a bit too, not up.

#4 Post by **suetemi** » Mon Apr 28, 2008 9:12 pm

Arvensis, just curious - how did recovery go for the 3 piece lefort? did you have any sinus or teeth complications? I'm perpetually seeking reassurance that a 3 piece lefort is not that terrible or scary.

#5 Post by **Arvensis** » Mon Apr 28, 2008 11:08 pm

I had one MINOR complication (hehe I say minor now that it all turned out well, but I admit I freaked out majorly at the time) - there was a hole in the upper palate between my sinus cavity and mouth, right where the three pieces of the lefort were sectioned and met. You can read about my freakout here: viewtopic.php?p=231879&highlight=#231879

Other than that, no complications. My OS was able to patch up the hole with a plastic shield he added to my splint - it allowed the hole to heal on its own, no problems. Mind, I'm honestly not sure how much of the issue was the lefort process or the complicated nasal stuff that was done on top of the lefort (I had an extremely deviated septum and they had to redo inside and outside of sinuses/nose to correct it, along with turbinectomy, and full rhinoplasty to comp for septum corrections being so drastic).

I've had no teeth complications; probably shouldn't compare sinuses since I had so much sinus work done on top of the lefort, but even then I've had nothing out of the ordinary. Feeling came back from rear molars forward, started with inside of mouth and in last months or so have gotten most if not all of the outside of upper jaw gum feeling back - anything not back yet, I can't even tell is missing.

I suspect that just doing a lefort is a lot easier than doing septo too at the same time, as since then I've read all these boards about septo and people just being knocked on their butts like nothing else for a week or so, which sounded about right

#6 Post by **phil** » Tue Apr 29, 2008 4:42 am

What I understand about the use of bone grafting is, that if the gap between the segments is larger than 5mm, bone grafting is called for. This is probably most often occurring in inferior repositioning of the maxilla, although defects in bone contact can occur with movement in any direction.

Remember, I'm not a professional--ask your surgeon!!!

#7 Post by **spartanfan72** » Tue Apr 29, 2008 8:17 am

I had a 3-piece Lefort done on Feb. 19th. Doc said he wouldn't know if he would have to do a graft until he got into the surgery.

He was pretty sure he wouldn't need to, but wouldn't rule it out.

It turned out that he didn't need to do the graft. Which was weird because he also said they widened my upper jaw as much as they possibly could.

It was widened and moved forward.

I'm 10-weeks post surgery today and I feel great.

#8 Post by **Arvensis** » Tue Apr 29, 2008 9:54 am

Interesting Phil!! I had 6 mm forward, around 1.5 mm expansion, no bone graft. It's the gap though, not how far forward, that you're referring to, correct? IE he could move my upper 6 mm forward, but b/c the bone shape/density whatever there could be less than 5 mm space between skull and palate segments.

From what my surgeon said, I think he would have added lower into the mix rather than bring the upper so far forward as to warrant a bone graft, for stability purposes. The man is also a completely anal perfectionist, which is good I suppose for someone redoing your face

#9 Post by **phil** » Wed Apr 30, 2008 12:14 pm

Arvensis,

That's right, gap BETWEEN segments.

#10 Post by **phil** » Wed Apr 30, 2008 6:39 pm

Meryaten,

I take that as high praise!