Premaxillary Osteotomy and Guided Tissue Regeneration in Secondary Bone Grafting in Children with Bilateral Cleft Lip and Palate

• Published in: The Cleft palate-craniofacial journal Vol. 44; no. 5; pp. 469 - 475
• Main Authors: Scott, Julia K., Webb, Roger M., Flood, Timothy R.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-09-2007; American Cleft Palate-Craniofacial Association; SAGE PUBLICATIONS, INC
• Subjects: Absorbable Implants; Alveoloplasty - methods; Biological and medical sciences; Birth defects; Bone Regeneration; Bone surgery; Bone Transplantation - methods; Child; Cleft Lip - surgery; Cleft Palate - surgery; Collagen; Cuspid - physiopathology; Deformities; Dentistry; Facial bones, jaws, teeth, parodontium: diseases, semeiology; Female; Guided Tissue Regeneration, Periodontal - methods; Humans; Male; Maxilla - abnormalities; Maxilla - surgery; Maxillofacial surgery; Medical sciences; Membranes, Artificial; Mouth; Non tumoral diseases; Orthopedic surgery; Osteotomy - methods; Otorhinolaryngology. Stomatology; Skin & tissue grafts; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps; Treatment Outcome; alveolar bone graft; guided tissue regeneration; bilateral; cleft; Human; Cleft palate; Secondary; Cleft lip; Osteotomy; Stomatology; Bone graft; Alveolar bone; Bilateral; Congenital cleft; Congenital disease; Guidance; Regeneration; Tissue; Treatment; Malformation; Surgery; Oral cavity disease; Child
• ISSN: 1055-6656; 1545-1569
• DOI: 10.1597/06-032.1

Objective:
To introduce a surgical technique for secondary alveolar bone grafting performed in conjunction with premaxillary osteotomy and guided tissue regeneration in children with bilateral clefts. This paper also looks at the outcomes of this surgery in a series of 15 consecutive patients.
Methods:
Secondary alveolar bone grafting (with a premaxillary osteotomy and guided tissue regeneration with a collagen membrane) is usually carried out in the mixed dentition stage. This retrospective study used patients’ medical records, radiographs, and clinical examination to assess the outcome of the surgery. Patients were followed up for an average of 3 years.
Results:
Bone grafting was successful in all cases. No premaxillae were lost and there was no long-term morbidity of the donor site. Radiographic assessment of the bone heights showed an average of 94% retention, 3 months postoperatively. Preliminary assessment of maxillary canine eruption is encouraging, with 79% being fully erupted in those patients who are at least 3 years post–bone grafting.
Conclusion:
Premaxillary osteotomy allows repositioning of the premaxilla to its optimal preplanned position and successful closure of all fistulae. We have found that use of a collagen membrane is a useful adjunct.