To report the surgical outcomes of secondary alveolar bone grafting with premaxillary osteotomy in a single surgeon cohort of complete bilateral cleft lip and palate patients.
Design
Retrospective review of 44 consecutive patients using hospital notes and radiographs.
Setting
Single specialist cleft lip and palate center, UK.
Patients
Consecutive patients with complete bilateral cleft lip and palate who were being treated with secondary alveolar bone grafting incorporating premaxillary osteotomy.
Outcome Measures
Assessment of success of bone graft by Kindelan score; canine eruption; closure of fistulae and assessment of morbidity.
Results
Between January 6, 2000, and August 8, 2013, 44 patients with complete BCLP underwent secondary ABG with a premaxillary osteotomy as a one-stage procedure. The mean follow-up was 7.3 years (range 1.4 to 14.6). Eighty-five percent of ABGs were successful (a Kindelan score of 1 or 2), and canine eruption was 89%. Failure of the ABG occurred in 7%. Fistulae recurrence rate was 11%, all of which were asymptomatic. No premaxillae were devitalized.
Conclusion
Incorporating a premaxillary osteotomy into the secondary ABG surgical protocol can be a safe technique that gives excellent surgical exposure for fistula repair.
CohenS.R., KalinowskiJ., LaRossaD., RandallP.Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management.Plast Reconstr Surg.1991; 87: 1041–1047.
4.
DaskalogiannakisJ., MehtaM.The need for orthognathic surgery in patients with repaired complete unilateral and complete bilateral cleft lip and palate.Cleft Palate Craniofac J.2009; 46: 498–502.
5.
El DeebM., MesserL.B., LehnertM.W., HebdaT.W., WaiteD.E.Canine eruption into grafted bone in maxillary alveolar defects.Cleft Palate J.1982; 19: 9–16.
6.
FreihoferH., van DammeP., Kuijpers-JagtmanA.Early secondary osteotomy-stabilization of the premaxilla in bilateral cleftsJ Craniomaxillofac Surg.1991; 19: 2–6.
7.
GeraedtsC., BorstlapW., GroenewoudJ., StoelingaP.Long-term evaluation of bilateral cleft lip and palate patients after early secondary closure and premaxilla repositioning.Int J Oral Maxillofac Surg.2007; 36: 788–796.
8.
GoodP., MullikenJ., PadwaB.Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate.Cleft Palate Craniofac J.2007; 44: 396–401.
9.
GoudyS., LottD., BurtonR., WheelerJ., CanadyJ.Secondary alveolar bone grafting: outcomes, revisions, and new applications.Cleft Palate Craniofac J.2009; 46: 610–612.
10.
HeidbuchelK., Kuijpers-JagtmanA., FreihoferH.An orthodontic and cephalometric study on the results of the combined surgical-orthodontic approach of the protruded premaxilla in bilateral clefts.J Craniomaxillofac Surg.1993; 21: 60–66.
11.
JiaY., JamesD., MarsM.Bilateral alveolar bone grafting: a report of 55 consecutively-treated patients.Eur J Ortho.1998; 20: 299–307.
12.
KamakuraS., YamaguchiT., KochiS., SatoA., MotegiK.Preliminary report of two-stage secondary alveolar bone grafting for patients with bilateral cleft lip and palate.Cleft Palate Craniofac J.2003; 40: 449–452.
13.
KimM.J., LeeJ.H., ChoiJ., KangN., LeeJ.H., ChoiW.J.Two-stage reconstruction of bilateral alveolar cleft using Y-shaped anterior-based tongue flap and iliac bone graft.Cleft Palate Craniofac J.2001; 38: 432–437.
14.
KindelanJ., NashedR., BromigeM.Radiographic assessment of secondary autogenous alveolar bone grafting in cleft lip and palate patients.Cleft Palate Craniofac J.1997; 34: 195–198.
15.
KohK.S., KimH., OhT.S., KwonS.M., ChoiJ.W.Treatment algorithm for bilateral alveolar cleft based on the position of the premaxilla and the width of the alveolar gap.J Plast Reconstr Aesthet Surg.2013; 66: 1212–1218.
16.
LuY., ShiB., ZhengQ., HuQ., WangZ.Incidence of palatal fistula after palatoplasty with levator veli palatini retropositioning according to Sommerlad.Br J Oral Maxillofac Surg.2010; 48: 637–640.
17.
MaineR.G., HoffmanW.Y., Palacios-MartinezJ.H., CurlewD.S., GregoryG.A.Comparison of fistula rates after palatoplasty for international and local surgeons on surgical missions in Ecuador with rates at a craniofacial center in the United States.Plast Reconstr Surg.2012; 129: 319e–326e.
18.
MuzaffarA.R., ByrdH.S., RohrichR.J., JohnsD.F., LeBlancD., BeranS.J., AndersonC., PapaioannouA.A.Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair.Plast Reconstr Surg.2001; 108: 1515–1518.
19.
PadwaB., SonisA., BagheriS., MullikenJ.B.Children with repaired bilateral cleft lip/palate: effect of age at premaxillary osteotomy on facial growth.Plast Reconstr Surg.1999; 104: 1261–1269.
PepperH.B., RevingtonP.J., DeaconS., ThomasS.Impact of secondary alveolar bone grafting on the symptoms of reflux in oronasal fistulas: a patient-related outcome study.Cleft Palate Craniofac J.2014; 51: 270–273.
22.
RevingtonP., McNamaraC., MukarramS., PereraE., ShahH., DeaconS.Alveolar bone grafting: results of a national outcome study.Ann R Coll Surg Engl.2010; 92: 643–646.
23.
ScottJ., WebbR., FloodT.Premaxillary osteotomy and guided tissue regeneration in secondary bone grafting in children with bilateral cleft lip and palate.Cleft Palate Craniofac J.2007; 44: 469–475.
24.
ScottJ.H., SymonsN.B.Introduction to Dental Anatomy.9th ed.Edinburgh: Churchill Livingstone;1982.
25.
SinghM., FloodT., MahmoodR., SanghrajkaN.Stabilisation of premaxillary segment in bilateral cleft palate during alveolar bone graft.Br J Oral Maxillofac Surg.2012; 50: 678–679.
26.
Theologie-LygidakisN., ChatzidimitriouK., TzerbosF., KolomvosN., IatrouI.Development of surgical techniques of secondary osteoplasty in cleft patients following 12 years experience.J Craniomaxillofac Surg.2014; 42: 839–845.
