25-year Follow-up of Primary Tibial Periosteal Graft for Hard Palate Repair in Cleft Lip and Palate: Outcomes, Concerns and Controversies

Abstract

Objective This study evaluates long-term outcomes in adults with Unilateral and Bilateral Cleft Lip and Palate (UCLP/BCLP) treated during the period 1992 to 1995 with tibial periosteal graft in primary repair. Design Retrospective study. Setting Department of Plastic and Maxillofacial Surgery, Children's Hospital Bambino Gesù (Italy). Patients The study included 52 patients with non-syndromic BCLP/UCLP who met the inclusion criteria. Interventions All patients underwent a standardized surgical protocol using a tibial periosteal graft as primary repair of the hard palate. Main Outcome Measure(s) Long-term outcomes on maxillary growth, residual oronasal fistula, and leg length discrepancy. Results About <2% of patients showed oral–nasal communication. Mean value of maxillary depth was 86° ± 4.5°. The lower value for maxillary retrusion was 76.8° in relation to the Frankfurt plane. At the x-ray control, 12.2% of patients showed leg discrepancy with a difference of always <2 cm. Conclusions The rate of maxillary retrusion obtained was the same if compared to other techniques. Tibial periosteal graft reduces the risk of fistula and the need for reintervention after secondary bone graft. The study did not observe negative impacts on leg growth after 25 years.

Alveolar Oral Layer Repair by Periosteal Grafts versus Maxillary Flaps and Gingivoperiosteoplasty: Techniques and Follow-up to Adolescence

“…32 Leg growth after tibial periosteal graft elevation does not have any adverse effects. 11 The invisibility of the graft donor site surgical scar is expected to show high score by the modern wound and scar digital and virtual assessment systems. [33][34][35] Comparable studies with higher case numbers and statistics would yield more supportive conclusions.…”

“…Periosteal grafts can be elevated large and long enough to accommodate wider clefts. Published studies on tibial graft-GPP are few, [7][8][9][10][11] and there has been a report 12 recommending calvarial periosteal graft for closure of large oronasal fistulas. Only one graft-versus-flap comparative study 7 appeared in the literature.…”