The “pocket” method of onlay bone grafting

Summary

There are several problems in bone grafting around the face. The first is that unless an intraoral approach is used, there is an external scar, which can be unsightly. The second is that resorption of the bone graft may occur. The third is that even with good pressure, hematoma may develop. In order to overcome some of these objections, a method of pocket bone grafting has been developed. From a remote area, hidden within the hairline or within the lower fornix of the eyelid, or using a previous scar, or with a buccal sulcus approach, a subperiosteal tunnel is elevated leading to a subperiosteal pocket overlying the defect. Through the subperiosteal tunnel, cancellous bone, or skull bone chips can be introduced and packed into the pocket until it is possibly some-what overfilled. A small suction drain can then be placed to drain any hematoma; it is then possible to manipulate the bone graft from the outside to give the desired contours. In the short term, this has been successful in that there has been no scarring. We have drained a significant amount of blood from the grafted areas in the first 48 h, and so far in the short-term follow-up, resorption has not been a problem, but this latter finding requires further study.