Donor Site - Lateral Ramus
Important: See notice at end of this page!
Incision and Disection
The incision, 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 region.
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.