title: Calvarial periosteal graft for second-stage cleft palate surgery: a preliminary report.
abstract: OBJECTIVE
  The objectives of cleft palate surgery are to achieve optimal outcomes regarding speech development, hearing, maxillary arch development and facial skull growth. Early two-stage cleft palate repair has been the most recent protocol of choice to achieve good maxillary arch growth without compromising speech development. Hard palate closure occurs within one year of soft palate surgery. However, in some cases the residual hard palate cleft width is larger than 15 mm at the age of two. As previously reported, integrated speech development starts around that age and it is a challenge since we know that early mobilization of the mucoperiosteum interferes with normal facial growth on the long-term. In children with large residual hard palate clefts at the age 2, we report the use of calvarial periosteal grafts to close the cleft.
  
  
  METHODS
  With a retrospective 6-year study (2006-2012) we first analyzed the outcomes regarding impermeability of hard palate closure on 45 patients who at the age of two presented a residual cleft of the hard palate larger than 15 mm and benefited from a periosteal graft. We then studied the maxillary growth in these children. In order to compare long-term results, we included 14 patients (age range: 8-20) treated between 1994 & 2006. Two analyses were conducted, the first one on dental casts from birth to the age of 6 and the other one based on lateral cephalograms following Delaire's principles and TRIDIM software.
  
  
  RESULTS
  After the systematic cephalometric analysis of 14 patients, we found no evidence of retrognathia or Class 3 dental malocclusion. In the population of 45 children who benefited from calvarial periosteal grafts the rate of palate fistula was 17% vs. 10% in the overall series.
  
  
  CONCLUSIONS
  Despite major advances in understanding cleft defects, the issues of timing and choice of the surgical procedure remain widely debated. In second-stage surgery for hard palate closure, using a calvarial periosteal graft could be the solution for large residual clefts without compromising adequate speech development by encouraging proper maxillary arch growth.
authors.affiliation: Department of Maxillofacial Surgery, University Hospital Center, Place Victor Pauchet, 80054 Amiens Cedex, France. Electronic address: cneivavaz@gmail.com.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Neiva
authors.affiliation: University of Picardie Jules Verne, Pôle santé 3, Rue DES LOUVELS 80036 AMIENS CEDEX 1, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dakpe
authors.affiliation: University of Picardie Jules Verne, Pôle santé 3, Rue DES LOUVELS 80036 AMIENS CEDEX 1, France.
authors.forename: Cica
authors.initials: C
authors.lastname: Gbaguidi
authors.affiliation: Facing Faces Institute, Amiens University Hospital Center, Place Victor Pauchet, 80054 Amiens Cedex, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Testelin
authors.affiliation: Facing Faces Institute, Amiens University Hospital Center, Place Victor Pauchet, 80054 Amiens Cedex, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Devauchelle
mesh_terms: D000293:Adolescent; D002508:Cephalometry / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D003724:Dental Arch / Q000254:growth & development; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007223:Infant; D007574:Jaw Relation Record; D008137:Longitudinal Studies; D008313:Malocclusion, Angle Class III / Q000517:prevention & control; D008334:Mandible / Q000033:anatomy & histology; D008437:Maxilla / Q000033:anatomy & histology / Q000254:growth & development; D003765:Models, Dental; D016155:Oral Fistula / Q000517:prevention & control; D021362:Palate, Hard / Q000601:surgery; D010521:Periosteum / Q000637:transplantation*; D063173:Retrognathia / Q000517:prevention & control; D012189:Retrospective Studies; D013165:Splints; D016896:Treatment Outcome; D014716:Vertical Dimension; D055815:Young Adult
keywords: Cleft lip and palate; Facial growth; Hard palate repair; Periosteal graft