Donor Site - Lateral Ramus . . .
Incision and Disection:
approximately 2.5 – 3.0 cm in length, extends in the free mucosa from the first molar to the third molar region, extending vertically along the external oblique ridge (see figure 1). Leave at
least a 5 mm cuff of tissue along the medial aspect of the incision line to facilitate closure (figure 2).
A mucoperiosteal flap is raised using a periosteal elevator. Care is taken to stay
sub-periosteally during the dissection. The lateral aspect of the mandibular body can be exposed to the mandibular border inferiorly. The lateral ramus including the external oblique ridge is accessible with
extension to the distal border of the ramus if required.
Harvest bone from any exposed bone surface. Lubricate the instrument by dipping it into saline. Press
down gently and use 1-2 cm strokes in an elliptical raking motion while maintaining an angle of 10-45o to the bone surface (see figures 3-4). The semi-circular blade cuts flat, convex and
concave surfaces. As the bone shavings flow into the handle, occasionally tap the end of the instrument on a table surface to advance the bone into the chamber if necessary.
To gain access to the collection chamber (figure 5), the locking button is depressed and the blade is retracted. If more than 2cc is to be harvested, the bone is placed in a sterile bowl (figure 6),
and another 2 cc's of bone can be harvested.
The osseous matrix is collected in the form of curved,
ribbon-like bone shavings with blood filling the highly porous matrix. The volume of the graft is at least 5-10 times greater than the volume the bone occupied prior to harvesting. The material is easily
handled and securely positioned in place.
The anterior extent of the incision in the buccal sulcus is limited by the mental nerve position in the pre-molar
Posteriorly, the extension of the incision is limited by the buccal nerve crossing over the anterior extent of the ramus is a moderately superior position.
Be sure that strokes are not too long where they
may leave the bone surface and possibly scrape over soft tissues.
Use a running closure with resorbable suture (e.g. 4-0 Vicryl
or Chromic). Irrigate, suction, and inspect the perimeter of the flap. Attempt to evert wound edges to optimize healing.
The incision and approach are
similar to vertical oblique ramus osteotomy. The extent of the dissection can be modified based on the amount of bone to be harvested.