An alveolar cleft (AC) is typically repaired using a non-vascularized bone graft from the iliac crest. Such alveolar bone grafts (ABGs) are reliable but not infallible. We present the case of an 18-year-old male with a persistent AC with the instability of the cleft-side medial incisor and canine, status post 4 failed ABGs. The medial femoral condyle (MFC) flap was chosen to provide vascularized and similarly contoured bone. The patient recovered well and now has adequate bone stock for dental restoration.
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