Osteoplasty of the alveolar cleft defect.

Cleft of lip, alveolar process and palate is the most common congenital defect affecting the face. It occurs at the time of early embryogenesis as a result of disturbed differentiation of the primordial cell layer and is associated with genetic and environmental factors. The most severe type of the defect is complete cleft of the lip, alveolar process and palate, unilateral or bilateral, which is accompanied by impaired breathing, sucking, swallowing, chewing, hearing and speaking. The treatment consists in the surgical reconnection (reconstruction) of the cleft anatomical structures and their formation to gain proper appearance, occlusal conditions and speech. The part of the surgical treatment is reconstruction of alveolar bone by means of autogenic spongy bone grafting (osteoplasty). The surgery performed at the stage of mixed dentition following an orthodontic treatment is a recognized standard management modality. Its effects provide stabilization of the dental arches fixed in the orthodontic treatment, possibility of growth of permanent teeth adjoining the cleft as well as separation of the nasal and oral cavities. The grafted bone becomes a platform for the collapsed base of the ala nasi and facilitates restoration of teeth loss. In the graft healing process the volume of the regenerated bone tissue is lower than the graft volume. Methods to augment the healed bone volume are being searched for, as this factor decides substantially on successful outcome of the surgery.

Bone graft healing in alveolar osteoplasty in patients with unilateral lip, alveolar process, and palate clefts.

Secondary osteoplasty by means of autogenic spongy bone grafting is the most common procedure used in the reconstruction of the continuity of the maxillary alveolar process. The aim of the study was to analyze retrospectively the effect of certain factors on the course of the bone graft healing process in patients with unilateral complete clefts of the lip, alveolar process, and palate. The investigations involved 62 children aged 8 to 14 years (mean age, 11 years) with unilateral complete cleft of the lip, alveolar process, and palate operated on at the Clinic of Plastic Surgery in Polanica Zdrój from November 2007 to April 2009. All the procedures consisted in the reconstruction of the maxillary alveolar process by means of autogenic spongy bone grafting from the iliac bone. The analysis was performed on the basis of computed tomography scans presenting maxillary alveolar processes in the horizontal cross-sectional planes performed on the second or third postoperative day and after 6 months. They were used as the basis for the measurement of the volume and density (condensation) of the bone graft, the surface of its adhesion to the maxillary alveolar bone, and the volume and density of the healed bone. The following correlation coefficients were determined: between the adhesion surface of the bone to the alveolar bone and the volume of the healed bone, between the adhesion surface of the bone to the alveolar bone and the density of the healed bone, and between the density of the graft and the volume of the healed bone. Increasing the surface of the graft adhesion to the bone ridges of the alveolar cleft contributes to increased volume of the healed bone and slows down the increase in its density (on 6-month follow-up). Crushing of the bone graft increases its resorption and reduces volume of the healed bone.

[Analysis of treatment results 389 patients with congenital blepharoptosis]. / Analiza wyników leczenia 389 chorych z wrodzonym opadaniem powiek.

PURPOSE: Retrospective analysis of the results in the treatment of congenital blepharoptosis. MATERIAL AND METHODS: We retrospectively reviewed the records of 389 patients with blepharoptosis who underwent surgical treatment in the Hospital of Plastic Surgery in Polanica-Zdrój, from January 1976 to January 2005. The age of patients, degree of malformation and unilateral or bilateral occurrence of ptosis, was analyzed. Moreover, we studied treatment results of patients with blepharoptosis treated in our hospital and patients treated elsewhere, before admission to our hospital. RESULTS: 218 patients from 327 operated in our hospital had levator muscle resections. After 6 months of observation 39 patients were qualified for surgical re-correction. 12 months after surgery 4 patients had recurrence of ptosis. Frontalis suspension technique with using the temporal fascia, was performed in 109 patients. After 6 months observation, 8 patients were qualified for surgical re-correction. CONCLUSIONS: For patients with maintained function of the levator muscle the most effective and physiological procedure, is the muscle shortening. Frontalis suspension technique with use of the temporal fascia should be limited to treat failure cases and patients with poor or absent function of the levator muscle.