A Tip for the Reconstruction of Larger Maxillary Defects in Complicated Cleft Patients

Abstract

Residual alveolar cleft deficits can be difficult to treat. This is particularly the case in older and multiply operated patients as well as those with large oronasal defects and extensive scar tissue. In large and recalcitrant defects vascularized free tissue transfer should be considered as a definitive procedure. Vascularized free tissue transfer provides a 95% success rate and provides excellent bone for placement of osseointegrated implants for dental rehabilitation (Schwabegger et al., 2004). We feel that the scapula tip has a number of important advantages. These include reduced morbidity from the donor site, good bone quality and contour for implant placement, and a longer pedicle length.

The Use of the Free Iliac Bone Flap by Shaping Like Puzzle for a Wide Alveolar Defect in a Bilateral Cleft Lip and Palate with Rudimentary Premaxilla

“…The feasibility of having 2 teams operating simultaneously whereas the patient is in a supine position offers a real advantage over the use of a scapular bone flap. 4 Another advantage of the iliac flap is the inconspicuousness of the donor site. The preauricular incision scar is not also a concern for any kind of patient.…”

“…In addition, the soft tissue around an inflamed oronasal fistula may not be reliable enough. 4 Bone transport distraction is a versatile method to make these deformities more amenable to bone grafting. In our case, unsuccessful bone grafting had been performed for one side of the bilateral alveolar cleft, and the deformity did not look promising for a second attempt for fistula closure and bone grafting.…”

“…The failure rate is very high in patients with wide clefts, owing to the lack of soft tissue in the cleft region. In addition, the soft tissue around an inflamed oronasal fistula may not be reliable enough 4 . Bone transport distraction is a versatile method to make these deformities more amenable to bone grafting.…”

“…The use of free vascularized bone flaps from scapula and distal medial femur have been reported for this purpose. 2,4 Since the first clinical description of the vascularized iliac flap in 1978, it has been used widely for mandibular and, to a lesser extent, for maxillary reconstructions. [5][6][7] We performed alveolar restoration and fistula closure with a vascularized iliac crest flap in a patient with bilateral cleft lip and palate.…”

“…Therefore, other techniques such as segmental osteotomies with distraction osteogenesis 3 or free osseous flaps can be used to avoid such complications in wide alveolar clefts. The use of free vascularized bone flaps from scapula and distal medial femur have been reported for this purpose 2,4 …”