The secondary bone grafting in cleft lip and palate: technical notes and indications about 62 cases

INTRODUCTION: Secondary bone grafting of the maxilla has become a well-accepted procedure in the surgical protocol for rehabilitation of patients with cleft lip and palate (CLP). The aim of this study is to review the surgical procedure and the indication of the secondary bone graft. MATERIALS AND METHODS: Sixty-two secondary bone graft were retrospectively reviewed from 1993 to 2000. There were 50 unilateral CLP and 12 bilateral CLP. The age at the time of bone grafting ranged from 9 years to 25.5 years with a mean at 14.34 +/- 2.9 years. The same operator performed a Gingivoperiosteoplasty (GPO) in all cases and the graft material was cancellous iliac bone in all cases. RESULTS: There were three indications of the bone graft and in each case the objective is different. First the interceptive bone graft in mixed dentition (50%): it was performed prior to the orthodontic treatment 12.8 +/- 2.3 years. The graft provides a bone support for teeth adjacent to the cleft. Second the stabilisation bone graft in permanent dentition (33.8%): it stabilize the orthodontic treatment and/or plan orthognathic surgery (15.2 +/- 1.6 years). Third the consolidation bone graft (16.2%): it was a late secondary bone graft after the complete growth (17,3 +/- 3,6 years) to correct the sequellae. It restored the maxilla continuity, stabilised the clefting teeth and prepared a prosthetic rehabilitation. CONCLUSION: The benefice of the secondary bone graft with GPO are numerous and is a part of the protocol treatment in CLP patients. A multidisciplinary follow up is necessary for the indication and timing of secondary bone grafting. The indication is subject to the clefting teeth, to the occlusal status and to the maxillary growth.