title: Review of secondary alveolar cleft repair.
abstract: BACKGROUND
  The alveolar cleft is a bony defect that is present in 75% of the patients with cleft lip and palate. Although secondary alveolar cleft repair is commonly accepted for these patients, nowadays, controversy still remains regarding the surgical technique, the timing of the surgery, the donor site, and whether the use of allogenic materials improve the outcomes. The purpose of the present review was to evaluate the protocol, the surgical technique and the outcomes in a large population of patients with alveolar clefts that underwent secondary alveolar cleft repair.
  
  
  METHODS
  A total of 109 procedures in 90 patients with alveolar cleft were identified retrospectively after institutional review board approval was obtained. The patients were treated at a single institution during a period of 10 years (2001-2011). Data were collected regarding demographics, type of cleft, success parameters of the procedure (oronasal fistulae closure, unification of the maxillary segments, eruption and support of anterior teeth, support to the base of the nose, normal ridge form for prosthetic rehabilitation), donor site morbidity, and complications. Pre- and postoperative radiological examination was performed by means of orthopantomogram and computed tomography (CT) scan.
  
  
  RESULTS
  The average patient age was 14.2 years (range 4-21.3 years). There were 4 right alveolar-lip clefts, 9 left alveolar-lip clefts, 3 bilateral alveolar-lip clefts, 18 right palate-lip clefts, 40 left palate-lip clefts and 16 bilateral palate-lip clefts. All the success parameters were favorable in 87 patients. Iliac crest bone grafts were employed in all cases. There were three bone graft losses. In three cases, allogenic materials used in a first surgery performed in other centers, underwent infection and lacked consolidation. They were removed and substituted by autogenous iliac crest bone graft.
  
  
  CONCLUSIONS
  THE USE OF AUTOGENOUS ILIAC CREST FOR SECONDARY ALVEOLAR BONE GRAFTING ACHIEVES ALL THESE SEVERAL OBJECTIVES: (1) to obtain maxillary arch continuity, (2) to maximize bone support for the dentition, (3) to stabilize the maxillary segments after orthodontic treatment, (4) to eliminate oronasal fistulae, (5) to provide nasal alar cartilage support, (6) to establish ideal alveolar morphology, and (7) to provide available bone with attached soft tissue for future endosteal implant placement in cases where there is a residual dental space. We advocate for the use of a minimal incision to obtain the iliac crest bone graft and for the use of a corticocancellous block of bone in combination with bone chips.
authors: Department of Plastic and Maxillofacial Surgery, Oral and Maxillofacial Surgery Unit, University Hospital Clínic i Provincial, Barcelona University. Barcelona, Spain ; Department of Pediatric Surgery, Oral and Maxillofacial Surgery Unit, University Hospital Sant Joan de Déu. Barcelona University. Barcelona, Spain.
authors: Gui-Youn
authors: GY
authors: Cho-Lee
authors: Eloy-Miguel
authors: EM
authors: García-Díez
authors: Richard-Agostinho
authors: RA
authors: Nunes
authors: Carles
authors: C
authors: Martí-Pagès
authors: Ramón
authors: R
authors: Sieira-Gil
authors: Alejandro
authors: A
authors: Rivera-Baró
keywords: Clinical evaluation; retrospective review; secondary alveolar cleft repair
references: J Oral Maxillofac Surg. 1996 Jan;54(1):83-8
references: 8531004
references: J Oral Maxillofac Surg. 2003 Sep;61(9):1078-81
references: 12966484
references: Cleft Palate J. 1986 Jul;23(3):175-205
references: 3524905
references: J Oral Maxillofac Surg. 2010 Jun;68(6):1283-9
references: 20304544
references: J Oral Maxillofac Surg. 1997 Mar;55(3):219-23; discussion 223-4
references: 9054909
references: J Oral Maxillofac Surg. 1991 May;49(5):493-8
references: 2019895
references: J Oral Maxillofac Surg. 2003 Sep;61(9):1082-90
references: 12966485
references: Cleft Palate J. 1990 Jul;27(3):225-8; discussion 229
references: 2372971
references: Oral Surg Oral Med Oral Pathol. 1987 Sep;64(3):278-82
references: 3309778
references: J Oral Maxillofac Surg. 1996 Jan;54(1):74-82
references: 8531003
references: Cleft Palate Craniofac J. 2009 Nov;46(6):610-2
references: 19860505
references: Cleft Palate Craniofac J. 2011 May;48(3):286-92
references: 20572777
references: Oral Maxillofac Surg Clin North Am. 2002 Nov;14(4):477-90
references: 18088649