title: Isolated keratinized gingiva incision in alveolar cleft bone grafts improves qualitative outcomes: a single surgeon's 23 year experience.
abstract: BACKGROUND
  Few publications have described the flap design of the secondary cleft alveoloplasty. In this article we describe a modified technique of the classical flap design with the purpose of minimizing injury to the dental papillae and periodontium of the involved dentition. We report our long-term experience, specifically with regards to oronasal fistulae recurrence, wound healing and graft exposure and loss.
  
  
  METHODS
  All the patients were operated on using the same technique by a single surgeon. A total of 148 clefts have been operated with this approach, involving 117 patients with complete cleft lip and palate with a follow-up between 12 and 240 months.
  
  
  RESULTS
  The most important finding in this study is the excellent wound healing observed in almost all patients. Only three patients (2%) suffered a dehiscence with oronasal fistulae recurrence and bone loss. Another patient lost the graft without fistula recurrence. Minor dehiscence with partial bone loss occurred in 4 patients (2.7%). These patients did not need surgical closure and only superficial exposed bone particles were lost without compromising the clinical outcome.
  
  
  CONCLUSIONS
  Our modification presents a flap design that is easy to elevate and mobilize, without disturbing the buccal sulcus or the gingival inter-dental papillae.
authors.affiliation: Department of Maxillofacial Surgery (Head: Jose L. López-Cedrún, MD, DDS, PhD), University Hospital A Coruña, Spain. Electronic address: lopezcedrun@centromaxilofacial.com.
authors.forename: Jose L
authors.initials: JL
authors.lastname: López-Cedrún
authors.affiliation: Cleft Unit, Department of Pediatric Surgery, Hospital of Cruces, Vizcaya, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Gonzalez-Landa
authors.affiliation: Department of Orthodontics, Rush Craniofacial Center, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Figueroa
mesh_terms: D000293:Adolescent; D000328:Adult; D000543:Alveoloplasty / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005893:Gingivoplasty / Q000379:methods*; D006085:Graft Survival; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009061:Mouth Mucosa / Q000601:surgery; D009297:Nasal Mucosa / Q000601:surgery; D009668:Nose Diseases / Q000601:surgery; D016155:Oral Fistula / Q000601:surgery; D011183:Postoperative Complications; D012008:Recurrence; D016156:Respiratory Tract Fistula / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: Alveolar bone graft; Cleft lip and palate; Incision design; Keratinized gingiva