The Effects of Secondary Cleft Procedures on Alar Base Position and Nostril Morphology in Patients with Unilateral Clefts

2017 ◽  
Vol 54 (4) ◽  
pp. 431-435 ◽  
Author(s):  
Stephanie M. Power ◽  
Damir B. Matic
Keyword(s):  
Bone Graft ◽  
Cleft Lip ◽  
Alveolar Bone ◽  
Nonparametric Tests ◽  
Single Stage ◽  
Base Position ◽  
Alar Base ◽  
Alveolar Bone Grafting ◽  
Tertiary Center ◽  
Long Term Follow Up

Objective To compare effects of secondary cleft procedures on alar base position and nostril morphology. Design Retrospective review. Setting Multidisciplinary cleft clinic at tertiary center. Patients, Participants Seventy consecutive patients with unilateral clefts were grouped according to secondary procedure. Interventions Alveolar bone graft versus total lip takedown with anatomic muscle repair versus single-stage total lip with cleft septorhinoplasty (nose-lip) versus rhinoplasty alone. Main Outcome Measures Anthropometric measurements were recorded from pre- and postoperative photographs. Ratios of cleft to noncleft side were compared within and across groups pre- and postoperatively using parametric and nonparametric tests. Results Within the bone graft group, no differences were seen postoperatively in alar base position in long-term follow-up. The total lip group demonstrated greater symmetry at the alar base ( P < .001), increased vertical lip dimension ( P < .001), and decreased nostril height ( P = .004) postoperatively. Within the nose-lip group, increased vertical dimension and alar base support ( P < .001) were also seen postoperatively. Across groups, the single-stage nose-lip group demonstrated greatest alar base symmetry on worm's-eye view ( P < .04). Conclusions Alar base asymmetry in patients with unilateral clefts may be related to soft tissue deficiency and was not affected by alveolar bone grafting. Total lip takedown with anatomic muscle reapproximation was associated with increased alar base symmetry and vertical lip dimension on cleft to noncleft side. Greatest symmetry at the alar base was seen following single-stage nose-lip reconstruction, which may be an effective technique for correcting the secondary cleft lip nasal deformity.

Long Term Effects of the Latham Presurgical Maxillary Orthopedic Appliance, Including Effects on Tooth Growth

2000 ◽  
Vol 8 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Michel C Samson ◽  
Donald H Lalonde ◽  
Donald Fitzpatrick ◽  
Gerald L Sparkes
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Alveolar Bone ◽  
Consistent Difference ◽  
Long Term Effects ◽  
Beneficial Effects ◽  
Alar Base ◽  
Alveolar Bone Grafting ◽  
Base Elevation

Reported beneficial effects of presurgical maxillary orthopedics in cleft lip include reduction of the cleft width, alignment of the maxillary segments, elevation of the alar base on the cleft side, diminished need for alveolar bone grafting and lip closure without tension. Possible adverse effects of presurgical maxillary orthopedics include tooth root damage and inability of periosteoplasty to make bone over the cleft. A series of wide cleft lip patients (n=15) treated with the Latham appliance at the time of lip closure were retrospectively compared with a similar group treated without the Latham appliance. The Latham appliance group (seven unilateral clefts, eight bilateral clefts; mean follow-up 9.5 years; range four to 18 years) was treated between the years 1980 and 1994. None of the 15 patients treated with the appliance had any tooth loss or damage attributable to the pins, and bone formation in the alveolar cleft was observed radiographically in all 13 of the patients who had a periosteoplasty at the time of lip repair, possibly obviating the need for secondary bone grafting. Five of these Latham group patients demonstrated clinical and radiographic evidence of tooth eruption into the periosteoplasty-formed bone. There was no consistent difference in the level of nasal alar base elevation in the two groups.

Racial Disparities Affect Timing of Alveolar Bone Grafting for Patients With Cleft Lip and Palate: An Analysis of the 2012 Kids’ Inpatient Database

FACE ◽  
2021 ◽  
pp. 273250162110485
Author(s):  
Alfredo Cepeda ◽  
Mary T. Austin ◽  
Phuong D. Nguyen ◽  
John F. Teichgraeber ◽  
Matthew R. Greives
Keyword(s):  
Bone Graft ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Sociodemographic Factors ◽  
Alveolar Bone Grafting ◽  
Income Quartile ◽  
Inpatient Database

Objective: The timing of alveolar bone graft (ABG) for patients with cleft lip and palate is critical to the success of the operation. Sociodemographic factors have been implicated in delaying surgery for other diagnoses but their impact on patients undergoing ABG is unknown. The purpose of this study is to examine the association of sociodemographic factors on the age of patients undergoing ABG. Methods: The Kids’ Inpatient Database (KID) from 2012 was used to define a cohort of patients with cleft lip and/or palate between the ages of 5 and 14. Patients were selected using ICD-9 procedure codes for repair of oronasal fistula and bone graft. Gender, race, income quartile, hospital region, and type of insurance were used as independent variables. Time to ABG was then calculated as hazard ratios (HR) of having surgery using Cox regression models with 95% confidence intervals. Results: A cohort of 395 patients was identified. Median age at ABG was 9 ± 0.15 years. On univariate analysis, Non-Hispanic Black (NHB) patients underwent surgery later than Non-Hispanic White (NHW) patients (11.13 ± 0.44 years vs 9.67 ± 0.19 years, P = .0026). Patients in the higher 2 income quartiles were more likely to have an early surgery as compared to those in the lowest quartile (9.16 ± 0.43 and 9.32 ± 0.43 years vs 10.20 ± 0.33, P = .016 and 0.043 respectively). No factor was significant on multivariate analysis. Conclusions: Patients who are NHB are associated with delayed time to ABG as compared to NHW. Conversely, those in the upper income quartile by zip code underwent surgery at an earlier age. While this study identifies demographic factors associated with delay of ABG, more research is needed to understand the direct causal effects for this delay in surgery and its implication for future growth and need for orthognathic surgery.

Alveolar Bone Grafting

2019 ◽  
pp. 95-98
Author(s):  
Raj M. Vyas ◽  
Gennaya L. Mattison
Keyword(s):  
Cleft Palate ◽  
Bone Graft ◽  
Bone Grafting ◽  
Crucial Role ◽  
Cleft Lip ◽  
Alveolar Bone ◽  
Mixed Dentition ◽  
Maxillary Expansion ◽  
Alveolar Bone Grafting ◽  
Cleft Lip Repair

Alveolar bone grafting plays a crucial role in cleft reconstruction. When neonatal presurgical orthodontia is successful in aligning the cleft segments, alveolar reconstruction can be initiated as a gingivoperiosteoplasty during primary cleft lip repair. In children with cleft palate, alveolar bone grafting is usually done after transverse maxillary expansion with a palatal expander. Exact timing of bone grafting is controversial; most centers initiate orthodontic evaluation/expansion between ages 7 and 8 years (beginning of mixed dentition) with an aim to bone graft before age 10 in order to allow osteogenic incorporation prior to eruption of the permanent canine teeth.

scholarly journals A CASE REPORT OF ELIMINATION OF ALVEOLAR DEFECTS BY SECONDARY BONE GRAFTING.

2020 ◽  
Vol 4 (9) ◽  
Author(s):  
Charan Teja Vemagiri ◽  
Damera Srikanth ◽  
Chandrababu V ◽  
Siva Ganesh
Keyword(s):  
Case Report ◽  
Bone Graft ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Iliac Bone Graft ◽  
Alveolar Bone Grafting ◽  
Successful Rehabilitation ◽  
Secondary Alveolar Bone Grafting

The secondary alveolar bone grafting is an integral component of contemporary rehabilitation of the patients with cleft lip and palate with alveolar defects. Iliac bone graft is frequent secondary graft used in the correction of alveolar defects. There is successful rehabilitation of osseous component post operatively.

Effect of Alveolar Bone Grafting in the Mixed Dentition on Maxillary Growth in Complete Unilateral Cleft Lip and Palate Patients

1997 ◽  
Vol 34 (5) ◽  
pp. 455-458 ◽  
Author(s):  
John Daskalogiannakis ◽  
R. Bruce Ross
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Statistical Significance ◽  
Analysis Of Covariance ◽  
Mixed Dentition ◽  
Research Centre ◽  
Alveolar Bone Grafting

Objective: This study was conducted to evaluate the effects on facial growth of alveolar bone grafting in the mixed dentition for patients with UCLP. Design: Retrospective cephalometric study. Setting: Craniofacial Treatment and Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada. Patients: The 58 patients participating in the study had a history of complete unilateral cleft lip and palate, all of which were repaired by the same plastic surgeon. Interventions: Twenty-one patients received an iliac-crest alveolar bone graft at a mean age of 10.3 years, while 37 did not receive an alveolar bone graft. Lateral cephalometric radiographs were obtained on all patients at two different times: at a mean age of 9.4 years (prior to bone grafting in the grafted group) and at a mean age of 15.2 years. Main Outcome Measures: All radiographs were traced and digitized by the same person, using cephalometric computer software. Superimposition and cephalometric analysis was undertaken to investigate the differences between the two groups in the 5.6-year experimental period. A two-way analysis of covariance was used for evaluation of the statistical significance of the results. Results: No statistically significant differences were found in 14 of the 15 cephalometric measurements performed. Harvold's maxillary unit length was statistically significantly shorter in the grafted group, although a lack of correlation with angular measurements and inherent problems with this specific measurement raise doubts in this finding. Conclusion: Mixed dentition bone grafting does not affect subsequent vertical and A-P development of the maxilla in complete unilateral cleft lip and palate patients during the first several postoperative years.

scholarly journals Secondary alveolar bone graft in incomplete unilateral pre-foramen fissure: case report

2022 ◽  
Vol 11 (1) ◽  
pp. e29111124969
Author(s):  
Luiza Roberta Bin ◽  
Eleonor Álvaro Garbin Júnior ◽  
Geraldo Luiz Griza ◽  
Natasha Magro Érnica ◽  
Mauro Carlos Agner Busato ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Clinical Case ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Treatment Protocols ◽  
Alveolar Bone Grafting ◽  
Embryonic Life ◽  
Secondary Alveolar Bone Grafting

Cleft lip and palate is one of the most common facial deformities. During embryonic life, non-fusion of the maxillary and medial nasal plaques leads to cleft lip and palate. Fissures can produce a range of dental problems in terms of number, size, shape, and position, related to deciduous or permanent dentition. Besides this, the teeth most affected are those located in the fissure area. There are numerous treatment protocols, which, despite the lack of a consensus, start as soon as the child is born, going into adulthood, seeking functional and aesthetic rehabilitation. The surgical phases, lip repair, nasal repair, palatoplasty and alveolar bone grafting, are performed according to age. As for the bone graft, the most used option is the secondary graft, with the autogenous one being the most available. Thus, the objective of this work is to present a clinical case of secondary alveolar bone grafting in a 10-year-old female patient with an incomplete unilateral pre-foramen cleft.

scholarly journals Alveolar cleft closure with iliac bone graft: a case report.

2017 ◽  
Vol 2 (1) ◽  
pp. 46
Author(s):  
Tichvy Tammama ◽  
Endang Syamsudin ◽  
Fathurachman Fathurachman
Keyword(s):  
Bone Graft ◽  
Alveolar Bone ◽  
Operative Management ◽  
Iliac Bone ◽  
Alar Cartilage ◽  
Alveolar Cleft ◽  
Alar Base ◽  
Iliac Bone Graft ◽  
Alveolar Bone Grafting ◽  
Cleft Closure

Objective: The present article is to report a case of a patient with alveolar cleft that was treated with the application of iliac bone graftMethods: A nine year-old girl with maxillary alveolar cleft had labioplasty and palatoplasty. The cleft was closed using iliac bone graft and the result was the canine erupts on the graft site get a better alveolar arch, and no more oronasal fistule. Alveolar cleft can be treated by the use of iliac bone graft.Results: Based on the clinical and radiographic development of the patient, the treatment for overall seemed success with the obtain of maxillary arch continuity, provide bone that is available for permanent canine to erupt, optimal alar base reconstruction, the fistulae was eliminated, provide a better nasal alar cartilage support, get a stabil the maxillary segment for orthodontic treatment, and obtain an ideal alveolar morphology.Conclusion: The timing of alveolar bone grafting usually associated with the state of the developing of dentition. Post operative management is important to get a good result, and to prevent any complications.

scholarly journals Alveolar bone grafting

2009 ◽  
Vol 42 (S 01) ◽  
pp. S110-S115
Author(s):  
Jan Lilja
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Mixed Dentition ◽  
Lateral Incisor ◽  
Canine Tooth ◽  
Alar Base ◽  
Alveolar Bone Grafting ◽  
Palate Bone

ABSTRACTIn patients with cleft lip and palate, bone grafting in the mixed dentition in the residual alveolar cleft has become a well-established procedure. The main advantages can be summarised as follows: stabilisation of the maxillary arch; facilitation of eruption of the canine and sometimes facilitation of the lateral incisor eruption; providing bony support to the teeth adjacent to the cleft; raising the alar base of the nose; facilitation of closure of an oro-nasal fistula; making it possible to insert a titanium fixture in the grafted site and to obtain favourable periodontal conditions of the teeth within and adjacent to the cleft. The timing of the ABG surgery take into consideration not only eruption of the canine but also that of the lateral incisor, if present. The best time for bone grafting surgery is when a thin shell of bone still covers the soon erupting lateral incisor or canine tooth close to the cleft.

scholarly journals Clinical Evaluation of Surgical Orthodontic Procedure with Bone Grafts for Patients with Cleft Palate during Adolescence

2021 ◽  
pp. 750-755
Author(s):  
Ravindra Manerikar ◽  
Shilpa Pharande ◽  
N. G Toshniwal ◽  
Kishor Chougule ◽  
Abhijit Misal
Keyword(s):  
Cleft Palate ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Multidisciplinary Approach ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Alar Base ◽  
Grafting Technique ◽  
Alveolar Bone Grafting

Background: Cleft lip and palate is a congenital anomaly, presenting in a wide variety of forms and combinations. Successful cleft lip and cleft palate rehabilitation requires a multidisciplinary approach employing the skills of different specialists. Aims & Objectives: The aim of this paper was to present orthodontic preparation of patients prior to alveolar bone grafting & to review our findings in a group of patients treated by secondary and delayed bone-grafting procedures at our institution. Methodology: Thirty eight patients were examined for the type of cleft and the age at the time of examination. 10 patients were treated in our institution with presurgical orthodontics & operated by a delayed bone-grafting technique.  Duration and type of expansion was noted at pre-operative, 2 months and 6 months. Crestal bone heights and the quality of the bone in the grafted areas was examined radiographically, along with presence of any fistulas. Results: All the patients demonstrated improved alar base and upper lip support, also better dental stability was seen in the region of cleft. Conclusion: All the patients included in this study appeared to benefit from the procedure with improved facial balance. In all ten patients the oronasal fistulas remained closed, hence was reported to be a success.

scholarly journals Maxillary Canine Impaction and Unilateral Cleft Lip and Palate: A Review of the Current Literature

2018 ◽  
Author(s):  
Ali Alqerban
Keyword(s):  
Bone Graft ◽  
Current Literature ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Dental Anomalies ◽  
Maxillary Canine ◽  
Alveolar Bone Grafting

The present review aims to investigate the effect of alveolar bone grafting in canine impacted unilateral cleft lip and palate patients. The goal of this review is to identify and highlight the factors that may cause maxillary canine impaction, the role of primary and secondary bone graft and dental anomalies that may affect canine impaction in patients with cleft lip and palate.

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