The use of free-periosteum for secondary bone grafting to the maxillary alveolar clefts

Some modification on the surgical technique for bone grafting to the alveolar clefts has been required. Secondary bone grafting was performed with and without free-periosteum on 34 (mean age, 9.8 +/- 1.1 years) and 44 (mean age, 10.7 +/- 1.2 years) alveolar clefts, respectively. Vertical bone formation which scored 3 or 4 was obtained in 97.1% of free-periosteum grafted clefts, while it was obtained in 79.5% of the control group. The rate of postoperative wound dehiscence in free-periosteum grafted clefts (20.6%) was not significantly different from the control group (11.4%). In the wound dehiscence cases, however, the grafted periosteum covered the grafted bone and prevented bone exposure. The score of bone formation in the free-periosteum grafted clefts (3.57 +/- 0.79) was significantly higher than that of the control group (2.60 +/- 1.34). Thus, free-periosteum grafting in secondary bone grafting is useful for bone formation in alveolar clefts.     

Long-term radiographic assessment of secondary alveolar bone grafting outcomes in patients with alveolar clefts.

OBJECTIVE: The objective of this study was to assess the outcomes of secondary alveolar bone grafting (SABG) in patients with complete, unilateral cleft lip and palate (UCLP) operated on before eruption of the permanent canine. STUDY DESIGN: Sixty-five periapical radiographs from 41 patients with left UCLP and 24 with right UCLP (9 to 12 years old at SABG), were analyzed retrospectively for the amount of bone in the cleft site according to the Bergland and Chelsea scales, and for the occurrence of canine eruption (CE) through the neoformed bone. RESULTS: Of the cases, 71% were classified as Bergland type I and Chelsea type A; 15% as types II/C, and 14% could not be classified. CE was observed in 95% of the cases operated on 4 years before the study. CONCLUSIONS: SABG performed before CE is a procedure with a high rate of success. The radiographic scales proved to be important instruments for assessing surgical outcomes.     

An atraumatic technique for harvesting cancellous bone for secondary alveolar bone grafting in cleft palate

Secondary alveolar bone grafting in cleft palate patients has been popularised by the Oslo group. Harvesting of the bone graft has been carried out by techniques developed initially for cranio-facial surgery. This paper describes a more refined technique applicable to the requirements of alveolar bone grafting. The Craig bone biopsy set is used to trephine cores of autogenous particulate marrow and cancellous bone from the iliac bone. The method was tested in a cadaver and then applied in 10 clinical cases. The aesthetic and functional results of this technique proved to be superior to the conventional approach.     

Dressing for alveolopalatal wounds after alveolar bone grafting

Cotton gauze with alpha cyanoacrylate was used for alveolopalatal wound dressing after alveolar bone grafting to treat 93 alveolar clefts in 74 cleft patients to reduce mechanical injuries, tension for wound dehiscence, and adhesion of food remnants. T-shaped cotton gauze was put on the gingivoperiosteal flaps and was impregnated with cyanoacrylate. The procedure required no preoperative preparation and its intraoperative execution took less than 5 minutes. The gauze with cyanoacrylate was removed approximately 1 week after surgery. No infection was observed at any of the operational sites, but tiny fistulas developed at four of them. The mean bone graft score was 1.4 point. No complications such as thermal injury resulted from the use of cyanoacrylate. Gauze impregnated with cyanoacrylate proved to be a convenient and dependable dressing for alveolopalatal wounds resulting from gingivoperiosteoplasty for alveolar bone grafting.     

Iliac crest autogenous bone grafting: donor site complications

Autogenous bone grafting is often done in orthopaedic surgery for a variety of conditions. The iliac crest is currently the most common donor site for obtaining autogenous bone graft. We searched the literature to summarize reported complications related to the donation of autogenous bone from the iliac crest. Our review revealed reports of arterial injury, ureteral injury, herniation, chronic pain, nerve injury, infection, fracture, pelvic instability, cosmetic defects, hematoma, and tumor transplantation. Currently, autogenous bone grafting is a necessary part of the treatment of various orthopaedic conditions. Obtaining bone from the iliac crest can be associated with significant morbidity. As bone grafting technology emerges, the known complications of the current standard should be weighed against the risk of alternate therapies.     

Assessment of secondary alveolar bone grafting using a modification of the Bergland grading system.

Although the management of the alveolar cleft remains controversial secondary alveolar bone grafting is the most widely accepted approach. The results of a series of 71 secondary alveolar bone grafts performed between 1990 and 2001 on 58 patients with complete cleft lip and palate 13 of which were bilateral are presented. Bone grafts were assessed when the canine tooth had fully erupted using periapical dental radiographs.The occlusal level of the newly obtained interdental bone of each grafted cleft was recorded and categorised in accordance with the Oslo grading system as described by Bergland. In addition the basal level of each bone graft was recorded. In this way total bone graft height was measured and each graft was categorised with respect to the desired normal height of noncleft interdental alveolar bone. This modified analysis grades more precisely the efficacy of secondary alveolar bone grafting and helps to identify and categorise those patients with insufficient bone for dental, orthodontic and orthognathic rehabilitation and those who may require further investigation and regrafting.     

Management of alveolar clefts

Treatment philosophies in the management of alveolar clefts have changed greatly over the years. Currently. the most widely accepted protocol is for repair using autologous cancellous bone from the iliac crest during the stage of mixed dentition. Preliminary data suggest that the appropriate age for surgical repair during the secondary phase can be decreased without evidence of limitation of facial growth. Further long-term studies are necessary to support this protocol, however. With a multidisciplinary approach between the various medical and dental specialties, it is now commonplace to achieve normal dentofacial aesthetics and function. The continued advances in medical and dental technology have further contributed to the excellent outcomes that are now achieved.     

Secondary alveolar bone grafting: An outcome analysis

OBJECTIVE

To review the outcome of secondary alveolar bone grafting in unilateral and bilateral cleft lip and palate.

DESIGN

A surgeon’s experience, by retrospective chart review, of 70 consecutive patients at a tertiary care centre.

OUTCOME MEASURE

Periapical radiographs were taken at least six months after secondary alveolar bone grafting. The Enemark grading system was used to stratify graft-take.

RESULTS

In unilateral clefts, 33% were level 1, 36% were level 2, 20% were level 3 and 11% were level 4. In bilateral clefts, 29% were level 1, 50% were level 2, 14% were level 3 and 7% were level 4. There was no statistically significant difference between the level of take and the type of cleft. Complications encountered were infection (n=3), fistula (n=3), pain (n=4) and bone graft exposure that led to failure (n=2). Two patients required reoperation for bone grafting.

CONCLUSIONS

The iliac crest is a good donor site with excellent results and minimal morbidity.     

不同术式的双侧牙槽嵴裂植骨术对唇、颊龈沟深度的影响

目的　研究不同术式的双侧牙槽突裂植骨术对唇、颊龈沟深度的影响。方法　对我科 1992年 4月至 2 0 0 2年 3月间采用 :①提袋手柄式瓣牙槽突裂修复术 ;②双颊瓣牙槽突裂修复术 ;③双颊瓣加鼻中隔犁骨凿断牙槽突裂修复的 4 2例牙槽突裂患者进行分析。结果　将术后唇颊龈沟变浅分为Ⅳ级 ,结果 4 2例中 ,0级 2 0例 ,占 4 7 6 % ;Ⅰ级 10例 ,占 2 3 8% ;Ⅱ级 10例 ,占 2 3 8% ;Ⅲ级2例 ,占 4 7%。采用提袋手柄式瓣和双颊瓣加犁骨凿断牙槽突裂修复术的 6例中 ,唇颊龈沟变浅 2 3者有 4例 ,唇颊龈沟消失者 2例 ,可见这两种术式均可使唇颊龈沟变浅。结论　三种术式均有使唇颊龈沟变浅之可能 ,术中应注意预防之     

Long-term outcome of secondary alveolar bone grafting in cleft lip and palate patients: A 10-year follow-up cohort study

Abstract

The objective was to assess the long-term outcome of secondary alveolar bone grafting (SABG) in cleft lip and palate patients and to examine relationships between preoperative and postoperative factors and overall long-term bone graft success. The records of 97 patients with cleft lip and palate, who had secondary alveolar bone grafting of 123 alveolar clefts, were examined. Interalveolar bone height was assessed radiographically a minimum of 10 years after grafting using a 4-point scale (I–IV), where types I and II were considered a success. After an average follow-up of 16 years after SABG (range = 10.2–22.7 years), 101 of the 123 grafts (82%) were categorised as successes. Mean age in the success group was 12.1 years and 13.6 years in the failure group (p = 0.03). It was found that the success rate was significantly lower (p = 0.02) if SABG was performed after eruption of the tooth distal to the cleft. No significant differences were found with regard to the other parameters investigated. The timing of secondary alveolar bone grafting is critical with regard to the age of the patient and the stage of eruption of the tooth distal to the cleft.     

影响唇腭裂患者牙槽裂植骨成功因素的临床研究

目的：分析影响唇腭裂患者牙槽裂植骨成功的因素。方法：对同一术者所行牙槽裂植骨术的唇腭裂患者52例进行临床研究，探讨植骨成功与手术年龄、手术类型、裂隙类型、裂侧类型等的关系。结果：18岁以上年龄组、完全性唇腭裂组、双侧唇腭裂组患者的植骨成功率与对应组相比有显著性差异，明显低于对应组。结论：①牙槽裂植骨成功与手术年龄、手术类型、裂隙类型、裂侧类型等有关；②良好植骨床的形成和植骨区无张力的严密缝合是保证牙槽裂植骨成功的关键；植骨时机是植骨成功与否的重要因素.     

自体髂骨皮质骨块与松质骨联合移植修复成人牙槽突裂19例分析

目的 观察自体髂骨块和松质骨联合移植修复成人牙槽突裂的效果.方法 对2008年以来在我院就诊的成人牙槽突裂患者19例采用自体髂骨块和松质骨联合移植修复.将髂松质骨填充牙槽突裂间隙内,用骨块恢复梨状孔边缘形态和鼻翼基底部高度后,采用微型钛板和单皮质钛钉固定.术后1年复查进行Bergland 分级评价.结果 植入骨成活率(Ⅰ～Ⅲ级)为84.2%,临床成功率(Ⅰ、Ⅱ级)为73.7%,临床失败率(Ⅲ、Ⅳ级)为26.3%.2例患者再次出现口鼻瘘孔.结论 自体髂骨块和松质骨联合移植修复成人牙槽突裂可以有效恢复牙槽突高度,增加患侧梨状孔周围骨量.     

Secondary bone grafting and orthodontic treatment in patients with bilateral complete clefts of the lip and palate

The results of secondary bone grafting and orthodontic treatment in 41 patients with bilateral complete clefts of the lip and palate are reported. Good bone formation was found in 98% of the cleft sites grafted before the eruption of the canines, and in 80% of the clefts grafted later. Closure of both cleft spaces by orthodontic means was achieved in 20 of the 21 patients in the first group, and in 14 of the 20 patients in the second group. The bone grafts failed in one cleft site in 4 patients, all of which were regrafted with satisfactory results. In 2 patients one of the canines was later affected by external root resorption, necessitating endodontic treatment. Both the failures and the root resorptions occurred in patients bone grafted at an older age than was considered optimal for bilateral clefts: 10 to 11 years. Seven patients needed a bridge prosthesis, 3 of these over one cleft space only. Even these patients benefited greatly from bone grafting.     

齿槽裂植骨整复畸形鼻

目的:探讨齿槽裂及鼻底进行天然多孔骨(Bio-OssCollagen材料)移植整复畸形鼻的可行性和临床疗效。方法:对12例齿槽裂及鼻底行Bio-OssCollagen材料植入整复手术。结果:随访9￣12月外形恢复良好,唇部和鼻底丰满,鼻翼提升,X线片示齿槽裂及鼻底植入Bio-OssCollagen材料基本被自体骨取代。结论:用Bio-OssCollagen材料代替自体骨植入齿槽裂及鼻底整复畸形鼻,均效果良好。     

Rare craniofacial clefts with duplication of alveolar arch

Summary A 16 year old girl presented with Tessier's No. 4 cleft on the right side coupled with No. 7 and No. 3 cleft on the left. Associated with this she had 6 molars in the left maxillary segment and a 7th unerupted one lying horizontally. Such a unique congenital anomaly has not been reported in literature until now.     

牙槽裂植骨同期鼻中隔骨支架植入鼻整形术

目的　研究在牙槽裂植骨修复的同时 ,利用自体髂骨皮质板块 ,修复单侧唇腭裂鼻畸形。方法　 10岁以后的单侧完全性唇腭裂患者 ,采用自体髂骨松质骨移植修复牙槽裂 ,同时采取髂骨内侧骨皮质修整后植入两侧鼻翼软骨内侧脚之间 ,形成鼻中隔前下部的骨性基础支架 ,将分离复位的鼻翼软骨内侧脚提升 ,使软骨穹窿顶超过骨性支架的上缘约 3mm ,将软骨缝合固定于骨性支架。结果　本组 2 4例患者均一期痊愈出院 ,患侧鼻翼基部凹陷、鼻小柱偏斜、鼻尖低平等畸形得到良好的矫正。结论　牙槽裂植骨与鼻畸形整复同期进行互不干扰。鼻中隔前骨性支架对鼻的外形结构有良好的支持作用 ,可以有效地矫正唇腭裂鼻畸形 ;与牙槽裂植骨同期进行 ,取材方便 ,减少了手术及麻醉的次数。     

The percutaneous trephine technique for harvesting iliac crest bone graft in alveolar clefts and its effect on donor site morbidity and quality of bone graft

The percutaneous trephine technique uses a bone marrow biopsy needle to harvest cancellous bone graft from the anterior iliac crest. The subjects of this study were 41 patients with 47 alveolar clefts who underwent secondary bone grafting over a period of 5 years, using the above technique. The donor site morbidity was evaluated retrospectively by means of a postal questionnaire and case note survey. Patients were questioned about severity of pain, duration of pain and duration of limping. None of the patients had donor site pain or limping for more than 2 weeks. No patient had severe donor site pain. Case note surveys revealed no donor site complications of haematoma, sensory disturbance, wound breakdown or contour abnormality. In 85.10% (n=40) of the alveolar clefts where the canine tooth had reached its final position at the bone grafted site, dental radiographs were used to assess the interalveolar septal height. In 82.5% (n=33) the interalveolar septal height was more than three quarters of normal i.e. a successful result. In conclusion the percutaneous technique causes minimal donor site pain and gait disturbance. It is a simple and safe technique, easy to learn and quick to perform leaving the patient with an imperceptible donor site scar. The results of clinical and radiological assessment of the quality of the bone graft also compare favourably with the conventional open technique of harvesting iliac crest graft in cases of alveolar clefts. Received: 31 December 1997 / Accepted: 20 July 1998     

Comparison of intraoral radiography and computed tomography in evaluation of formation of bone after grafting for repair of residual alveolar defects in patients with cleft lip and palate.

For one year we studied postoperative computed tomograms (CT) and intraoral radiographs for 29 patients with unilateral alveolar clefts. Interdental bone height and the bony boundary on the nasal side were assessed on intraoral films and compared with the evaluation by CT. Twenty-four cases had adequate interdental bone height as assessed by intraoral films. However, 10 of these 24 cases showed insufficient anteroposterior depth on CT. Two of the remaining five cases were also overestimated by the intraoral radiograph. All cases had sufficient bony boundary on the nasal side on intraoral radiography. However, CT showed that bone formation on the nasal side off two cases was significantly worse than that on the non-cleft side. Consequently, about 40% of surgical outcomes may be overestimated by intraoral radiographs. CT therefore seems to give a better assessment of the clinical outcome than intraoral radiographs and should be considered as an adjunct in difficult clinical cases.