Abstract
Secondary bone grafting into alveolar cleft has become a very popular procedure. At our department, alveoloplasty has been performed by transplanting cancellous bone from the ilium to the cleft maxilla in cooperation with the Orthodontic Department since 1994.However, sometimes it is difficult to prepare a graft bed of sufficient size for safe bone transplantation because of difficulty in closing the mucoperiosteum of the nasal cavity. If the mucoperiosteum of the cleft maxilla is dissected or damaged during surgery before bone grafting and so is not available for suturing over the graft bed, complications can occur. In such cases, artificial dermis has been used with favorable results. Our technique for using artificial dermis and some representative patients will be presented.
Operative procedure:The mucoperiosteum at the cleft is dissected so that it can be used to close the palatal and nasal cavity defects. However, in some patients, the mucoperiosteum on the median side (unaffected side) is absent, so that the nasal cavity defect cannot be completely closed. In such cases, a graft bed that had no fistula with the nasal cavity can be prepared by placing artificial dermis over the mucoperiosteal defect.
Postoperative complications included a fistula and bone gra ft resorption in one patient undergoing surgery using artificial dermis. This was probably because the patient had mental retardation and refused to rest appropriately. In three patients without artificial dermis grafts, fistulas also developed after surgery. These patients underwent treatment before artificial dermis was used to cover defects of the mucoperiosteum. Recently, artificial dermis has been used in all patients with mucoperiosteal defects, and the postoperative results have improved.
Artificial dermis is produced from bovine dermal collagen. It blocks communication between the bone graft bed and the nasal cavity, and it may also contribute to mucosal regeneration through gradual replacement by granulation tissue.
The use of artificial dermis caused no side effects such as infection or allergic reaction. This material has already been used in the field of oral surgery. In the field of plastic surgery, it has also been employed to cover dermal defects that cannot be treated by primary skin grafting and its usefulness has been demonstrated.
Whether the artificial dermis was replaced by mucoperiosteum after surgery and whether it promoted the development of mucosa could not be confirmed. However, this material was useful in patients with mucoperiosteal defects.
