RECONSTRUCTION OF ATROPHIC MAXILLA BY ANTERIOR ILIAC CREST BONE GRAFTING VIA NEUROAXIAL BLOCKADE TECHNIQUE: A CASE REPORT

Anterior iliac crest bone grafting is a well-established modality in the treatment of alveolar bone deficiencies. However, this procedure may also have considerable postoperative morbidity which is mostly related to general anesthesia. Postoperative pain-related complications can be managed by neuroaxial blockade techniques which provide adequate surgical analgesia and reduce postoperative pain. This clinical report describes the reconstruction of a severely atrophic maxilla with anterior iliac crest bone grafting using combined spinal epidural anesthesia. Neuroaxial blockade techniques may be a useful alternative to eliminate general anesthesia related challenges of anterior iliac crest bone grafting procedures.

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  • Mertens C, Decker C, Seeberger R, Hoffmann J, Sander A, Freier K. Early bone resorption after vertical bone augmentation--a comparison of calvarial and iliac grafts. Clin Oral Implants Res 2013;24(7):820-825.
  • Kahnberg KE, Vannas-Lofqvist L. Maxillary osteotomy with an interpositional bone graft and implants for reconstruction of the severely resorbed maxilla: A clinical report. Int J Oral Maxillofac Implants 2005;20(6):938-945.
  • Nystrom E, Ahlqvist J, Gunne J, Kahnberg KE. 10-year follow-up of onlay bone grafts and implants in severely resorbed maxillae. Int J Oral Maxillofac Surg 2004;33(3):258-262.
  • Swan MC, Goodacre TE. Morbidity at the iliac crest donor site following bone grafting of the cleft alveolus. Br J Oral Maxillofac Surg 2006;44(2):129-133.
  • Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, Angelillo IF, Mosteller F. The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-analyses of randomized, controlled trials. Anesth Analg 1998;86(3):598-612.
  • Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. BMJ 2000;321(7275):1493.
  • Beirne JC, Barry HJ, Brady FA, Morris VB. Donor site morbidity of the anterior iliac crest following cancellous bone harvest. Int J Oral Maxillofac Surg 1996;25(4):268-271.
  • Myeroff C, Archdeacon M. Autogenous bone graft: Donor sites and techniques. J Bone Joint Surg Am 2011;93(23):2227-2236.
  • Wiltfang J, Schultze-Mosgau S, Nkenke E, Thorwarth M, Neukam FW, Schlegel KA. Onlay augmentation versus sinuslift procedure in the treatment of the severely resorbed maxilla: A 5-year comparative longitudinal study. Int J Oral Maxillofac Surg 2005;34(8):885-889.
  • O'Neill KR, Lockney DT, Bible JE, Crosby CG, Devin CJ. Bupivacaine for pain reduction after iliac crest bone graft harvest. Orthopedics 2014;37(5):e428-434.
  • Joshi A, Kostakis GC. An investigation of post-operative morbidity following iliac crest graft harvesting. Br Dent J 2004;196(3):167-171; discussion 155.
  • Racle JP, Benkhadra A, Poy JY, Gleizal B, Gaudray A. [comparative study of general and spinal anesthesia in elderly women in hip surgery]. Ann Fr Anesth Reanim 1986;5(1):24-30.
  • Collins TC, Daley J, Henderson WH, Khuri SF. Risk factors for prolonged length of stay after major elective surgery. Ann Surg 1999;230(2):251-259.