title: Treatment algorithm for bilateral alveolar cleft based on the position of the premaxilla and the width of the alveolar gap.
abstract: OBJECTIVE
  The efficacy of conventional secondary bone grafting is limited in instances of a bilateral alveolar cleft with a wide cleft gap and malpositioning of the premaxilla. The purpose of this study is to suggest a systematic algorithm to guide individualised treatment of a bilateral alveolar cleft according to the position of the premaxilla and the width of the alveolar gap.
  
  
  METHODS
  A total of 51 patients with bilateral alveolar clefts were investigated between January 2000 and February 2008. The average age was 9.2 years, and the mean follow-up period was 47 months. Conventional alveolar bone grafting (ABG) was performed for patients with both a narrow cleft gap and acceptable position of the premaxilla. Patients with both a wide cleft gap and acceptable premaxilla position were initially managed by interdental distraction osteogenesis. Premaxilla repositioning was indicated in patients with both sagittally and/or vertically unfavoured positioning of the premaxilla. The extent of bone resorption following bone grafting was evaluated using the Abyhölm criteria.
  
  
  CONCLUSIONS
  Of 102 grafts, 98 grafts (96.1%) showed satisfactory bony take (Grade I-II). Only four grafts (3.9%) exhibited a poor outcome, with more than 50% bony resorption (Grade III-IV). The average hospital stay was 5.7 days and no serious complications were observed. Our approach resulted in satisfactory surgical outcomes. This suggests the feasibility of a standardised approach for the correction of a bilateral alveolar cleft. Our algorithm should be helpful for systematic and coordinated team approaches to rectify bilateral alveolar clefts.
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. kskoh@amc.seoul.kr
authors.forename: Kyung S
authors.initials: KS
authors.lastname: Koh
authors.forename: Hoon
authors.initials: H
authors.lastname: Kim
authors.forename: Tae Suk
authors.initials: TS
authors.lastname: Oh
authors.forename: Soon Man
authors.initials: SM
authors.lastname: Kwon
authors.forename: Jong Woo
authors.initials: JW
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000539:Alveolar Process / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002972:Cleft Palate / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008437:Maxilla / Q000002:abnormalities / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Alveolar bone graft; Bilateral alveolar cleft; Premaxilla