Healing of large dentofacial defects

Dentofacial defects can be small or very large, consisting of defects in the craniomaxillofacial region with missing soft tissue, bony and other hard tissue components. Such combined mucosal, osseous and even cartilaginous defects can be reconstructed using flaps and bone grafts, or hopefully, in the future with bone graft substitutes or even tissue engineered constructs. The healing of such wounds always relies on the vascularity of the surrounding tissues. This chapter seeks to provide a physiological basis for the mechanisms involved in the healing of such large complex defects. The reconstruction of specific defects must follow sound and logical surgical principles. The authors employ the concept of the reconstructive surgical ladder, in which techniques of step-wise increasing complexity are used with a strong preference for the simplest possible procedure at the outset. A number of techniques are presented along with the principles of tissue engineering and the basis for bone regeneration using adipose derived stem cells, growth factors and resorbable scaffolds.