Primary Alveolar Bone Grafting and Gingivoperiosteoplasty or Gingivomucoperiosteal Flap at the Time of 1-Stage Repair of Unilateral Cleft Lip and Palate

Abstract

It takes quite a long time to finish treating patients with cleft lip and palate. Usually, lip closure, palate repair, secondary alveolar bone grafting, and secondary repair of lip/nose have been given to patients at appropriate time according to their growth. However, these series of surgical interventions impose a considerable burden on the patients and their families. As for palate repair, it is considered that the earlier the better for the sake of speech, but it should be delayed to approximately 1(1/2) years of age for maxillary growth. However, we have developed a palate repair technique that will hardly result in marked maxillary growth impairment by modifying the Furlow method, so we have become able to perform palate repair between 3 and 10 months after birth. Accordingly, we can perform lip and palate repair simultaneously, which have been performed separately. As we have developed a 1-stage repair of cleft lip and palate including primary alveolar bone grafting from nasal concha and/or hard plate and gingivoperiosteoplasty or gingivomucoperiosteal flap, we report on our technique and treatment outcome.

Generation of a bioengineered autologous bone substitute for palate repair: anin vivostudy in laboratory animals

“…Clinical and experimental results suggest that interposition of a bone graft may significantly improve the clinical outcome and functional results of patients with cleft palate, especially when an alveolar cleft is present (Torikai et al ., ; Dik et al ., ; Isik et al ., ; Shirani et al ., ; Cho‐Lee et al ., ; Hara et al ., ). However, harvesting autologous bone grafts is painful and is usually associated with side‐effects at the donor area (Laurie et al ., ; Ophof et al ., ; Meara et al ., ; Sharma et al ., ).…”

Epithelial–Mesenchymal Interactions as a Working Concept for Oral Mucosa Regeneration

“…Clinical uses for a tissue-engineered mucosa graft include not only intraoral defects, 13 such as repair of acquired or congenital oral mucosal defects, 14 but also the reconstruction of the cornea, 15 eyelids, conjunctiva, 16 esophagus, 17 trachea, 18 bladder, 19 urethra, 19 or vagina. 20 Other potential uses of tissue-engineered mucosa grafts are in vitro models to study the biology and pathology 21 and as a vehicle for delivery and expression of transduced genes.…”

“…Cultured oral mucosa equivalents have been applied in patients following resection of mucosal tumor with some levels of short-term clinical success. 14,27 One of the goals of tissue engineering is to shorten in vitro cultivation time and apply tissue-engineered constructs in vivo at early time points in in situ regeneration approaches. 28 …”

Ultrasound Evaluation of Primary Alveolar Grafting in Cleft Lip/Palate Treatment: Development of a Novel Sonographic Grading System

“…Current techniques involving minimal dissection in the anterior maxillary plane have shown promise in stabilizing the transverse maxillary arch and decreasing occlusal distortions with minimal differences in facial growth when compared with gingivoperiostoplasty or secondary bone grafting (Rosenstein et al, 1991; Eppley, 1996; van Aalst et al, 2005). Various authors describe different sources of material for primary alveolar grafting, including rib (van Aalst et al, 2005), nasal conchal bone and/or hard palate (Torikai et al, 2009), and absorbable collagen sponge infused with recombinant human bone morphogenic protein-2 (rhBMP-2; Fallucco and Carstens, 2009). At this institution, select patients with unilateral cleft lip/palate with a well-approximated alveolar cleft undergo primary alveolar repair.…”