[Development of the maxilla in patients with complete unilateral cleft palate surgically treated by a periosteal transplantation technic. A retrospective study of 15 surgical cases with an 18 year follow-up].
OBJECTIVE
The aim of this study was to assess retrospectively the long-term growth of the maxilla in subjects with unilateral total cleft treated initially with the tibial periosteal graft technique.


METHODS
The study group included 15 patients with a mean 18 years follow-up (range 15-20 years). All patients had been operated on by the same surgeon. Only patients in stage DP3, one to two years after peak growth were retained for review. Delaire's architectural analysis was used to study anteroposterior and vertical growth of the maxilla. Transverse growth was studied with the Mars occlusal score. Bone generation induced by the periosteum was studied using the Björk Holmgren analysis. The quality of the palatine and nasal repair was studied using Pruzansky's criteria.


RESULTS
Anteroposterior and vertical growth led to a normal maxilla in 53.3% of the cases and a moderate to severe retromaxilla (> 5 mm) in 46.7%. Complete symmetry was achieved for the nasal fossae in 20% of the cases and marked asymmetry was noted in 26%. The height of the nasal fossae was symmetrical in 60% of the cases with marked asymmetry in 26%. Mean production of alveolar bone reached 58% of the height of the alveolar bone filling. It was good in 46.6% of the cases, fair in 26.7% and weak in 26.7%. The occlusal score evidenced crossed occlusion in 33.3% of the cases for a hemisection and in 46.7% of the cases for an anterior section. Normal occlusion was achieved in 20%. The quality of palatine repair was found to be good with a normal mucosa in 86.7% of the cases. A fistula was present in 13.3%.


CONCLUSIONS
The preoperative objectives of periosteal graft repair of unilateral complete clefts were achieved. This technique provides a closed scar-free palate. Nasal repair favored the development of an ample and functional airway. The periosteal graft produced bone in the anterior portion allowing a harmonious premaxillary region and stable nose support.
Bonin
B
B
Chirurgie Maxillo-Faciale et Stomatologie, CHU Trousseau, 37044 Tours.
Picard
A
A
Stricker
M
M
D000293:Adolescent; D000328:Adult; D000539:Alveolar Process / Q000254:growth & development / Q000473:pathology; D002972:Cleft Palate / Q000473:pathology / Q000601:surgery*; D003766:Dental Occlusion; D005146:Facial Asymmetry / Q000145:classification; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008310:Malocclusion / Q000145:classification; D008437:Maxilla / Q000254:growth & development* / Q000473:pathology / Q000601:surgery; D009061:Mouth Mucosa / Q000473:pathology; D009296:Nasal Cavity / Q000254:growth & development / Q000473:pathology; D016155:Oral Fistula / Q000145:classification; D010012:Osteogenesis / Q000502:physiology; D010159:Palate / Q000254:growth & development / Q000473:pathology; D010521:Periosteum / Q000637:transplantation*; D012189:Retrospective Studies; D014716:Vertical Dimension; D014945:Wound Healing