Onlay iliac bone grafting as an ancillary augmentation procedure for paranasal rejuvenation during bimaxillary surgery

Objective: The aim of this paper is to present the outcome of iliac bone block grafts used for paranasal augmentation during bimaxillary orthognathic surgery for the patient with deep concavity of canine fosse. Study design: Preoperative evaluation of the patient, done with 3-dimensional (3D) surgical simulation software, revealed deep bony concavity of paranasal area and insufficient soft tissue improvement when Le Fort I level maxillary advancement was accomplished. The deficient sites were grafted and better profile was achieved with 3D simulation. After the leveling phase, Le Fort I advancement and mandibular setback with sagital split osteotomies were performed. Bony deficiency of paranasal regions were corrected simultaneously with autogenous iliac block grafts to obtain maximum improvement in the profile. Results: More satisfactory esthetic results were obtained with paranasal augmentation, and acceptable profile was provided for the patient. Conclusions: Bimaxillary orthognathic surgery combined with augmentation of paranasal area is an efficient method to obtain better aesthetic outcome for patients with severe concave profile. Paranasal augmentation with iliac bone block grafting is a novel technique to ensure favorable soft tissue support and esthetic appearance of the patient.