Whereas autologous bone replacement was earlier applied in maxillofacial surgery virtually only for the restoration of mandibular defects and for the osteoplasty of patients with cleft alveolar process, the free transplantation of autologous bone (spongiosa or cortical bone or both) is nowadays primarily used for implantological purposes. Autologous bone is still the gold standard for bone replacement. This is the case even though a wide selection of bone substitutes is currently available, with which new bone equivalent to autologous bone can be produced in certain cases. Autologous bone is often obtained from intraoral sources, but if a larger quantity of spongiosa is required, these sites (the chin, the retromolar area of the mandible, the muscular process, etc.) are not suitable. Of the extraoral donor sites, the most frequently used site is the iliac crest, but the proximal epiphysis of the tibia is also appropriate for this purpose since we have recently performed bone transplantations on appreciable numbers of patients, we decided to compare the morbidity data relating to the two donor sites. In the 9 months between March and November 2007, sinus elevations were carried out on 14 patients with bone taken from the tibia, while in 38 patients bone was taken from the iliac crest for osteoplasty on clefted alveolar process. The comparison was based on postoperative clinical examinations, the complaints of the patients and objective study of the morbidity relating to the two donor sites. Clinically the patients tolerated both interventions well. Mobilization took place on the day of intervention. There were no major complications; one minor haematoma was observed after each type of surgery. The postoperative complaints of the patients did not reveal any essential difference. Following bone harvesting from the iliac crest, the gait of the patients slightly hampered for up to 10 to 14 days. In the tibia cases, the patients experienced no pain on walking by the second day. As regards donor site morbidity, protracted (1-2 weeks) oedema was observed after hip surgery, with paraesthesia of the area of innervation of the n. cutaneus femoris lateralis in 1 case, while there was a minor seroma following tibia surgery in 1 case. Our clinical experience suggests that, if 10-15 cm3 spongiosa is required for augmentation purposes and there is no need for cortical bone, the patient is exposed to less stress when bone is taken from the proximal epiphysis of the tibia.
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