Bone grafting the piriform aperture deformity in isolated cleft lip patients: indication, technique, and results.
OBJECTIVE
This study was undertaken to determine the effect of a bone graft in the piriform aperture on the nasal deformity and orthodontic treatment of the cleft side teeth in isolated cleft lip patients.


METHODS
All primary cleft lip repair was done 3 months after birth. Nine patients, four female and five male, with a mean age of 12.5 years (range, 8.2 to 24.8 years) and with a repaired cleft lip, were bone grafted between 1992 and 1996. The mean postoperative period was 2 years (range, 1 to 4 years). An iliac crest bone graft was placed in the piriform aperture deformity on the side of the cleft lip. The improvement in the nasal symmetry and angulation of the cleft side teeth were evaluated. The eight growing cleft lip patients (mean age, 11 years; range, 9 to 13 years) were compared with a control group of eight healthy growing children (mean age, 11 years; range, 9 to 13 years). The improvement of nasal symmetry was measured by the formula of the lobule portion of the columella index preoperatively and postoperatively.


RESULTS
The mean lobule portion of the columella index preoperatively was 41.8% (SD, 4.4%; SE of Mean, 1.5%) and postoperatively was 44.2% (SD, 4.9%; SE of Mean, 1.6%) (P > .006, t-test for paired samples). The angulation of the cleft side teeth was improved by orthodontic treatment.


CONCLUSIONS
Bone grafting the piriform aperture deformity results in a stable result and improves nasal symmetry and the angulation of the cleft side teeth.
van der Wal
K G
KG
Frisian Cleft Palate Team, Medisch Centrum Leeuwarden, The Netherlands.
van der Meulen
B D
BD
van der Biezen
J J
JJ
Mulder
J W
JW
D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods; D016022:Case-Control Studies; D002648:Child; D002971:Cleft Lip / Q000000981:diagnostic imaging / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium; D008297:Male; D008310:Malocclusion / Q000473:pathology / Q000628:therapy; D008445:Maxillofacial Development; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009666:Nose / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009667:Nose Deformities, Acquired / Q000000981:diagnostic imaging / Q000601:surgery*; D009971:Orthodontics, Corrective; D011862:Radiography, Panoramic; D014070:Tooth / Q000000981:diagnostic imaging / Q000473:pathology