Secondary bone grafting of alveolar clefts has been performed in 109 cleft palate patients, 55 boys and 54 girls, using the autogenous particulate cancellous bone and marrow of the iliac bone. The patients age range was 8 years 2 months to 28 years 8 months, with a mean age of 12 years 11 months.
Before the bone grafting, any malocculusion of the maxillary segments were corrected with orthodontic treatment. Operation was done with simultaneous correction of alveolar clefts and oral-nasal fistulas.
The incision made along the clefts margin of the labial site, mucoperiosteal flap was developed.
Mucoperiosteum of the fistula was dissected and separated the palatal and nasal portion with scissors. The mucoperiosteum were closed with stiches in each.
At this point, nasal and palatal layers of mucoperiosteum had been created. Cancellous bone and marrow were packed into any spaces, and placed in the area of the alar base. After an adequate osseous form was obtained, the labial mucoperiosteum was undermined and relaxed, and closed with stiches. But, the cases of great oral-nasal fistulas, labial sulcus flap used closure of the labial and palatal portion of oral-nasal fistula.
Secondary bone grafting of alveolar clefts has following benefits to cleft palate patients.
1) Stabilization of the maxillary segment.
2) Closure of oral-nasal fistulas.
3) Support of the slumping alar base of the nose.
4) Restoration of alveolar process and dental arch.
5) Provision of bone support for unerupted canine.
These advantages of secondary bone grafting were results of short term observation, but, in the future, long term observation is necessary.
