To define the optimal timing for secondary bone grafting to the alveolar clefts, we studied the effects of early secondary bone grafting on maxillary growth.
The subjects were 13 patients with unilateral cleft lip/palate (UCLP) who had undergone bone grafting at 5 or 6 years of age (range: 5 years 10 months-6 years 10 months, mean: 6.2years) from December 1993 through February 1998. As control 6 other patients with UCLP who did not undergo bone grafting until 10 years of age were studied. Maxillary growth was compared between the two groups by means of maxillary plaster casts taken at selected intervals from 6 to 10 years of age. The results of analyses showed that the width of the tuber maxillary regions and molar regions and the alveolar arch length of the maxilla grew significantly from 6 to 10 years of age, regardless if bone grafting was done or not. Although the width of the canine regions significantly increased in patients who had not undergone bone grafting until 10 years old, the growth of the canine regions seemed to be inhibited when the patients underwent bone grafting at 5 or 6 years of age. Several studies have reported that the width of the canine regions reaches the peak value when the permanent incisors start to erupt, with minimal growth after the eruption of the incisors is completed.
From these, it was suggested that bone grafting should be avoided in patient with 5 or 6 years of age, before the permanent incisors have started to erupt.
