title: Secondary bone grafting of the cleft maxilla following reverse quad-helix expansion in 103 patients.
abstract: BACKGROUND
  The main points to consider in secondary alveolar bone grafting (ABG) of cleft patients are age at the time of surgery, the type of bone graft, and pre/postorthodontic expansion of the upper jaw.
  
  
  OBJECTIVE
  The aim of this study is to evaluate the reverse quad-helix (RQH) expander device. Does RQH improve the surgical procedure before ABG? We will evaluate the outcome of the procedure, duration of the operation, hospitalization time, satisfaction of the surgeon with this procedure and the success of the bone graft in the long-term.
  
  
  METHODS
  We reviewed the medical records of 103 cleft patients who underwent secondary bone grafting at our institution between 2001 and 2012. All patients were treated presurgically with a RQH appliance to expand the cleft area. The following data were recorded for each of the patients: Unilateral/bilateral cleft, surgery time, hospital stay, success/failure, and follow-up.
  
  
  CONCLUSIONS
  Presurgical orthodontic application of the RQH expander in the cleft area enabled improved anterior expansion rather than posterior expansion. This technique improves access for surgery and bone grafting, the use of RQH facilitates the improved manipulation of the nasal mucosa via direct view due to the wide separation of the alveolar segments in the cleft area. Furthermore, this gap enables improved access for the bone grafting procedure, shortens the surgery time and provides stable maxillary transverse correction.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Omri
authors.initials: O
authors.lastname: Emodi
authors.affiliation: Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Dani
authors.initials: D
authors.lastname: Noy
authors.affiliation: Orthodontic and Craniofacial Center, Graduate School of Dentistry, Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Hagai
authors.initials: H
authors.lastname: Hazan-Molina
authors.affiliation: Orthodontic and Craniofacial Center, Graduate School of Dentistry, Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Dror
authors.initials: D
authors.lastname: Aizenbud
authors.affiliation: Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Rachmiel
keywords: Cleft palate; maxillary expansion; reverse quad-helix; secondary bone graft