Alveolar Cleft Reconstruction Using Double Iliac Corticocancellous Bone Plates Grafting Technique in Mixed Dentition Phase

2021 ◽  
pp. 105566562110421
Author(s):  
Mohammed Omara ◽  
Mamdouh Ahmed ◽  
Mohamed Shawky ◽  
Sherif Ali
Keyword(s):  
Bone Density ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Contralateral Side ◽  
Bone Plates ◽  
Mixed Dentition ◽  
Alveolar Cleft ◽  
Oronasal Fistula ◽  
Grafting Technique ◽  
Cleft Lip Palate

Objective The primary goal of maxillary alveolar cleft reconstruction in patients with cleft lip/palate at the phase of mixed dentition is to build bone in the cleft area which in turn allows closure of the oronasal fistula, establishes arch continuity, and improve maxillary stability. This study aimed to evaluate the double iliac corticocancellous bone plates grafting technique for initial alveolar cleft grafting. Design This prospective study was conducted on 12 consecutive patients with unilateral complete alveolar cleft and previous cleft lip and palate corrective surgery. Intervention For all patients, the iliac crest graft was harvested and cut into 2 cortical bone plates and adapted labially and palatally. Both plates were fixed with screws then the gap between the 2 plates was filled with cancellous bone. The grafted side was compared to the contralateral side 9 months postoperatively regarding labio-palatal alveolar width and bone density, while the 9 months postoperative graft height was compared to the immediate postoperative height using computed tomography scans. Results All grafted sides showed similarity to the contralateral sides regarding both alveolar width and bone density with minimal crestal bone resorption. Conclusion The double iliac corticocancellous bone plate grafting technique seems to be a reliable method for alveolar cleft reconstruction with adequate bone quality and contour.

scholarly journals Alveolar cleft and maximum cleft width as predictors for difficult laryngoscopy and intubation in patients with unilateral complete cleft lip and palate

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Gamal A. Abdelhameed ◽  
Wael A. Ghanem ◽  
Simon H. Armanios ◽  
Tamer Nabil Abdelrahman
Keyword(s):  
Body Weight ◽  
Odds Ratio ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Difficult Laryngoscopy ◽  
Secondary Outcome ◽  
Pediatric Airway ◽  
Alveolar Cleft ◽  
Cleft Lip Palate ◽  
Width Measurements

Abstract Background Cleft lip and palate is one of the commonest congenital anomalies, which have an impact on feeding, speech, and dental development away from the significant psychosocial sequel. Early surgical repair aims to restore appearance and function, and the modern techniques can leave many defects undetectable. Therefore, the anesthetic challenge facing the pediatric airway with such abnormalities is still of a great impact. The aim of our study among 189 patients enrolled is to correlate alveolar gap and maximum cleft width measurements as predictors of difficult laryngoscopy and intubation in infants with unilateral complete cleft lip/palate aging from 1 to 6 months. As a secondary outcome, their weight is to be correlated too as another parameter. Results The alveolar gap and maximum cleft width are both of equal high predictive power (p value ≤ 0.001) with 100% sensitivity for both and specificity of 76.10% and 82.39% respectively, with a cut off value of ≤ 10 mm and 11 mm for these dimensions respectively, and odds ratio of incidence of difficult intubation is 4.18 and 5.68 respectively, while body weight ≤ 5.75 kg has an odds ratio of 2.32. Conclusion Alveolar cleft and maximum cleft width can be used as predictors for anticipation of difficult laryngoscopy and intubation infant patients with unilateral complete cleft lip and palate, while body weight ≤ 5.75 kg increases the risk more than twice.

scholarly journals Association of the profile of individuals with cleft lip/palate with the beginning of orthopedic/ orthodontic treatment

RSBO ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 86-93
Author(s):  
Madiana Magalhães Moreira ◽  
Pedro Diniz Rebouças ◽  
Maria Lúcia Bonfim Chagas ◽  
Luan Cartaxo Félix ◽  
Paulo Goberlânio de Barros Silva ◽  
...  
Keyword(s):  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Geographic Origin ◽  
Panoramic Radiograph ◽  
Mixed Dentition ◽  
Chi Square ◽  
Reference Hospital ◽  
Cleft Lip Palate ◽  
Chi Square Test

Cleft lip and palate (CLP) is the most frequent congenital malformation among the anomalies of the head and neck. The orthopedic/orthodontic treatment is included in the rehabilitation of these individuals, however there is no consensus in the literature regarding the ideal time for its beginning. Objective: To verify and characterize the profile of individuals with CLP treated at a reference hospital of the northeast of Brazil from 1998 to 2013 and its association with the beginning of the orthopedic/ orthodontic treatment. Material and methods: Through direct observation of medical records, panoramic radiograph, and study casts of 323 individuals, data regarding sex, cleft type, origin and age of beginning of the orthopedic/orthodontic treatment were surveyed and analyzed using the chi-square test, considering a 5% level of significance. Results: Most of the individuals had transforamen and the unilateral cleft was the most prevalent (p<0.05). Females were statistically more affected by post-foramen cleft and males by trans-foramen cleft (p><0.05). Most individuals with trans-foramen cleft and post-foramen cleft started the orthopedic/ orthodontic treatment between 8 and 12 years old (p><0.05). No statistically significant differences occurred relating the beginning><0.05). Females were statistically more affected by post-foramen cleft and males by trans-foramen cleft (p<0.05). Most individuals with trans-foramen cleft and post-foramen cleft started the orthopedic/ orthodontic treatment between 8 and 12 years old (p<0.05). No statistically significant differences occurred relating the beginning> <0.05). No statistically significant differences occurred relating the beginning of the orthopedic/orthodontic treatment with geographic origin and sex of, although most of them have started treatment at late mixed dentition. Conclusion: Regardless of gender, origin, or cleft type, most patients started orthopedic treatment up to 12 years-old, an age considered ideal by most protocols. Unilateral and trans-foramen cleft were the most prevalent cleft types. post-foramen cleft affected more females, while trans-foramen cleft affected more males.

scholarly journals Current concept in alveolar cleft management

2017 ◽  
Vol 10 (4) ◽  
pp. 195 ◽  
Author(s):  
Mohammad Sayedur Rahman Khan ◽  
Mei Shuang ◽  
Xiao Lin Liu ◽  
Sun Xu ◽  
Hao Fu Liang
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Mixed Dentition ◽  
Developmental Defect ◽  
Allogeneic Bone ◽  
Alveolar Cleft ◽  
Oronasal Fistula ◽  
Alar Base

<p class="Abstract">The alveolar cleft is known as the developmental defect of bone in alveolar process of maxillae which occurs in 75% of the cleft lip and palate patients with different types of clinical presentation like unilateral or bilateral and complete or incomplete. Secondary alveolar cleft reconstruction with autogenic spongy bone grafting (osteoplasty) at the stage of mixed dentition is commonly accepted treatment to help in the maintenance of maxillary arch continuity, repairing of oronasal fistula, eruption of the permanent dentition, enhancement of nasal symmetry through providing alar base support and improving speech. As of late, conflicting argument of alveolar cleft management is continuing regarding treatment planning with timing, graft materials, surgical techniques as well as methods of evaluation of the progress of alveolar osteoplasty. Now-a-days, experiments have made for the application of allogeneic bone, artificial bone, and recombinant human bone morphogenetic protein (rhBMP), along with growth factors to diminish the donor-site morbidity associated autogenic bone grafting. The purpose of this review is to discuss about pathogenesis and aetiology of cleft defects, surgical techniques, assessment of progress of alveolar bone graft and proposed future materials for bone graft.</p>

scholarly journals Orthognathic Surgery Combined with Orthodontic Treatment in a Patient with Bilateral Cleft Lip, Palate and Alveolus, Without Alveolar Bone Graft: A Case Report

2021 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Yudi Siswanto ◽  
Magda Rosalina Hutagalung ◽  
Indri Lakhsmi Putri ◽  
Jusuf Sjamsudin
Keyword(s):  
Bone Graft ◽  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Alveolar Cleft ◽  
Bilateral Cleft Lip ◽  
Cleft Lip Palate

Background: The incidence of cleft lip and palate is 8 in every 10,000 live births. A patient with this condition experiences a deficiency in maxillary growth. Maxillary hypoplasia leads to malocclusion and skeletal disharmony. Orthognathic surgery at skeletal maturity is the standard procedure at the end of the protocol to correct maxillary hypoplasia resulting in malocclusion not correctable with orthodontics alone.Case Presentation and Operation Technique: We report the result of orthognathic surgery performed on a 23 year old male with complete bilateral cleft lip, palate, and alveolus. We proceeded with bimaxillary surgery despite the alveolar cleft. We also recorded a neglected alveolar cleft in which he should have had undergone alveolar bone graft prior to the current procedure. The pre-maxillary segment was stabilized with miniplate followed by Le Fort 1 advancement and mandibular setback guided by an occlusal wafer. Malar augmentation was done by onlay bone grafts. Mandibulo-maxillary fixation was maintained. Postoperatively, a good occlusion and better facial harmony were achieved. He was planned to undergo a septorhinoplasty in the near future.Discussion: Despite adequate treatments following the protocol recommended by many centres, some patients developed some degree of maxillary hypoplasia. A quarter of this population need osteotomies and Le Fort I maxillary osteotomy is the most common procedure to correct retrognathic maxilla.Conclusion: Orthognathic surgery combined with orthodontic treatment in a patient with bilateral cleft lip and palate provided good functional and aesthetic result. However, this procedure cannot replace the standard protocol of having an alveolar bone graft performed before permanent canine eruption to achieve optimal outcomes

Preliminary Report of Two-Stage Secondary Alveolar Bone Grafting for Patients with Bilateral Cleft Lip and Palate

2003 ◽  
Vol 40 (5) ◽  
pp. 449-452 ◽  
Author(s):  
S. Kamakura ◽  
T. Yamaguchi ◽  
S. Kochi ◽  
A. Sato ◽  
K. Motegi
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Contralateral Side ◽  
Two Stage ◽  
Alveolar Cleft ◽  
Alveolar Bone Grafting ◽  
Bilateral Cleft Lip ◽  
Secondary Alveolar Bone Grafting

Objective To overcome the difficulties of one-stage secondary alveolar bone grafting for patients with bilateral cleft lip and palate (BCLP) who have a broad alveolar cleft, the value of two-stage alveolar bone grafting was examined. Patients Three patients (2 girls and 1 boy) with BCLP were treated by two-stage alveolar bone grafting. The procedure consisted of a first-stage surgery (mean age 8 year 6 months ± 7.8 months), which consisted of alveolar bone grafting for one side of the BCLP, and second-stage surgery for the contralateral side several months later. For the postoperative assessment, radiographs of the operated site were examined. Results The average amount of implanted bone per operation and per patient was 6.8 ± 1.1 g and 13.7 ± 1.0 g, respectively. Postoperative clinical and radiographic examinations revealed that an appreciable alveolar bone ridge had formed, and there were no major complications. Conclusions Two-stage alveolar bone grafting, which makes it possible to reduce the amount of implanted bone, could be an optional surgical procedure for patients with BCLP and a broad alveolar cleft.

scholarly journals Association of the profile of individuals with cleft lip/palate with the beginning of orthopedic/ orthodontic treatment

RSBO ◽  
2017 ◽  
Vol 1 (2) ◽  
pp. 86 ◽  
Author(s):  
Madiana Magalhães Moreira ◽  
Pedro Diniz Rebouças ◽  
Maria Lúcia Bonfim Chagas ◽  
Luan Cartaxo Félix ◽  
Mário Rogério Mota
Keyword(s):  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Geographic Origin ◽  
Panoramic Radiograph ◽  
Mixed Dentition ◽  
Chi Square ◽  
Reference Hospital ◽  
Cleft Lip Palate ◽  
Chi Square Test

Cleft lip and palate (CLP) is the most frequent congenital malformation among the anomalies of the head and neck. The orthopedic/orthodontic treatment is included in the rehabilitation of these individuals, however there is no consensus in the literature regarding the ideal time for its beginning. Objective: To verify and characterize the profile of individuals with CLP treated at a reference hospital of the northeast of Brazil from 1998 to 2013 and its association with the beginning of the orthopedic/ orthodontic treatment. Material and methods: Through direct observation of medical records, panoramic radiograph, and studycasts of 323 individuals, data regarding sex, cleft type, origin and age of beginning of the orthopedic/orthodontic treatment were surveyed and analyzed using the chi-square test, considering a 5% level of significance. Results: Most of the individuals had transforamen and the unilateral cleft was the most prevalent (p<0.05). Females were statistically more affected by post-foramen cleftand males by trans-foramen cleft (p<0.05). Most individuals with trans-foramen cleft and post-foramen cleft started the orthopedic/ orthodontic treatment between 8 and 12 years old (p<0.05). No statistically significant differences occurred relating the beginning of the orthopedic/orthodontic treatment with geographic origin and sex of, although most of them have started treatment at late mixed dentition. Conclusion: Regardless of gender, origin, or cleft type, most patients started orthopedic treatment up to 12 years-old, an age considered ideal by most protocols. Unilateral and trans-foramen cleft were the most prevalent cleft types. post-foramen cleft affected more females, while trans-foramen cleft affected more males.

scholarly journals Alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients using cone-beam computed tomography evaluation

2021 ◽  
Author(s):  
Marcin Stasiak ◽  
Anna Wojtaszek-Słomińska ◽  
Bogna Racka-Pilszak
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Contralateral Side ◽  
Cone Beam ◽  
Rank Test ◽  
Cross Sectional ◽  
Alveolar Bone Grafting

Abstract Purpose The aims of this retrospective cross-sectional study were to measure and compare labial and palatal alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients, following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Patients and methods The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography was performed at least one year after secondary alveolar bone grafting. The experimental side was the cleft side and the contralateral side without congenital cleft was the control. Measurements were performed on incisors’ midsagittal cross-sections. The Wilcoxon signed-rank test was used for intergroup comparisons. Results The labial and palatal distances between alveolar bone crests and cementoenamel junctions were significantly greater on the cleft side than on the noncleft side. Mean differences were 0.75 and 1.41 mm, respectively. The prevalence of dehiscences at the cleft side maxillary central incisors was 52% on the labial surface and 43% on the palatal surface. In the controls, it was 19% and 14%, respectively. Conclusion The cleft-adjacent maxillary central incisors had more apically displaced alveolar bone crests on the labial and palatal sides of the roots than the controls. Higher prevalence of dehiscences was found on the cleft side. Bone margin differences predispose to gingival height differences of the central incisors. These differences could increase the demands of patients to obtain more esthetic treatment results with orthodontic extrusion and periodontal intervention on the cleft side.

Rehabilitation of a Patient with Cleft Lip and Palate with an Extremely Edentulous Atrophied Posterior Maxilla Using Zygomatic Implants: Case Report

2004 ◽  
Vol 41 (5) ◽  
pp. 571-574 ◽  
Author(s):  
Anh Viet Pham ◽  
Marcelo Abarca ◽  
Albert De Mey ◽  
Chantal Malevez
Keyword(s):  
Case Report ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Oral Implants ◽  
Alveolar Cleft ◽  
Dental Prostheses ◽  
Posterior Maxilla ◽  
Zygomatic Implants ◽  
Dental Rehabilitation

Objective This case report describes the clinical and surgical management of a patient with a unilateral alveolar cleft and associated extremely atrophied totally edentulous maxilla. Method Two zygomatic implants and four endosseous oral implants were placed under general anesthesia in a compromised maxilla to rehabilitate a 33-year-old patient with cleft lip and palate. The two specially designed zygomatic implants were utilized to avoid the need for bone grafting in the patient. The final prosthetic rehabilitation was an esthetic and functional maxillary overdenture prosthesis supported by implants. Results Preliminary results have shown how dental prostheses supported by endosseous implants in grafted alveolar cleft are a reliable possibility in the dental rehabilitation of this malformation. Conclusion The use of zygomatic implants may be considered a reliable alternative to more resource-demanding techniques such as bone grafting in patients with cleft palate.

Repair of Recurrent Cleft Palate with Free Vastus Lateralis Muscle Flap

2012 ◽  
Vol 49 (2) ◽  
pp. 245-248 ◽  
Author(s):  
Jose G. Christiano ◽  
Amir H. Dorafshar ◽  
Eduardo D. Rodriguez ◽  
Richard J. Redett
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Vastus Lateralis ◽  
Muscle Flap ◽  
Free Flaps ◽  
Vastus Lateralis Muscle ◽  
Oronasal Fistula ◽  
Lateralis Muscle ◽  
Palate Repair

A 6-year-old girl presented with a large recalcitrant oronasal fistula after bilateral cleft lip and palate repair and numerous secondary attempts at fistula closure. Incomplete palmar arches precluded a free radial forearm flap. A free vastus lateralis muscle flap was successfully transferred. No fistula recurrence was observed at 18 months. There was no perceived thigh weakness. The surgical scar healed inconspicuously. Free flaps should no longer be considered the last resort for treatment of recalcitrant fistulas after cleft palate repair. A free vastus lateralis muscle flap is an excellent alternative, and possibly a superior option, to other previously described free flaps.

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