[The bony deficit in cleft lip and palate: review of procedures. Experience with the tibial periosteal graft].
Surgeons have long been preoccupied with continuity of the bone in the repair of cleft lips and palates. It is no longer necessary to demonstrate the deleterious effect of employing osteoplasty in a first stage procedure; very few practitioners still rely upon it. On the other hand, a great number of authors now advocate a bone graft as a secondary operation, although they have not been able as yet to reach a consensus on its timing, nor upon exactly what its objectives should be. An early bone graft, carried out at the time of the primary dentition, would have as its goal stabilization of the maxillary segments and prevention of relapse of the maxillary retrusion as the dentition becomes mixed. Any hopes that such an intervention would have a beneficial effect with regard to the area of the lateral incisors, which are usually malformed or absent, seem to us illusory. A secondary bone graft, undertaken during the mixed dentition before the eruption of the canines, when a maxillary bony deficit is present with accompanying alveolar insufficiency. We consider that a distinction between the areas of bone, the maxillary and the alveolar, is essential because a continuity of maxillary bone, a guarantee of skeletal stability, can be obtained in more than 70% of cases by perio-osteoplasty (a graft of tibial periosteum or gingivo-perio-osteoplasty). When this cannot be done, a massive bone graft will be needed at the close of orthopedic treatment. Continuity of alveolar bone, the guarantee of occlusal stability, can be obtained at the close of orthodontic treatment with the use of a provisional prosthesis followed by a permanent replacement after completion of gingival correction. We believe a graft to prepare for an implant in an area where scar tissue can be a problem would be risky especially since implants, in our opinion, do not provide the same stability to a dental arch that a fixed bridge affords.
Morand
B
B
Service de Chirurgie Plastique et Maxillo-Faciale, Centre Hospitalier Universitaire de Grenoble, Hôpital Albert Michallon.
Duroure
F
F
Raphaël
B
B
D000328:Adult; D000367:Age Factors; D000539:Alveolar Process / Q000002:abnormalities / Q000601:surgery; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000601:surgery* / Q000628:therapy; D005260:Female; D005893:Gingivoplasty; D006801:Humans; D007223:Infant; D008297:Male; D008313:Malocclusion, Angle Class III / Q000601:surgery / Q000628:therapy; D008437:Maxilla / Q000601:surgery; D019647:Oral Surgical Procedures / Q000379:methods*; D009971:Orthodontics, Corrective; D010521:Periosteum / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods; D013977:Tibia