Secondary Alveoloplasty Using Iliac Cancellous Bone Graft in the Cleft Lip and Palate Patients

ABSTRACT

Maxillar bone of the patients with complete cleft lip and palate showed delayed growth pattern due to defect of bone formation and bony defect of cleft site, maxillary retrusion and defect and displacement of lateral incisor and canine. In the patients with bilateral cleft lip and palate, there are more severe bony defect and hypoplasia which leads to premaxillar instability and maxillary retrusion and makes the Type III malocclusion. In these patients, the reason for secondary bone graft to alveolar cleft after surgery of cleft lip and palate is to provide the stability of maxillary arch, to create bony matrix through which the teeth can erupt and to construct the plateform of the alar base for improving nasal and upper lip symmetry. There are many arguement about preferred timing of bone graft and donor site of bone graft, but we performed secondary bone graft for 16 alveolar cleft patients who is between the ages of 7 to 10 years, and we have followed up during 1 to 5 years. We harvested cancellous bone from iliac bone for donor, performed cancellous bone graft to alveolar cleft, and then sutured gingival flap water tightly, and applied Coe-pak on the operation site for protecting graft site after bone graft. As a result of radiograph for the quality of graft "take", there were little of bony absorption in 70% of cases, partial bony absorption in 30% of cases. By alveoloplasty with bone graft, there were improvement and harmony in nose, upper lip and alveolar arch. The patients with remnant alveolar fistula also were repaired, and permanent teeth were erupted with good shape. Results were satisfactory in the almost patients