A New Technique in Alveolar Cleft Bone Grafting for Dental Implant Placement in Patients With Cleft Lip and Palate.

OBJECTIVE: To evaluate 2 iliac corticocancellous-block grafting techniques for dental implant placement in residual alveolar clefts. DESIGN: Nonrandomized prospective clinical trial between March 2010 and December 2014. SETTING: National Hospital of Odonto-Stomatology, Hanoi, Vietnam. PARTICIPANTS: Thirty-two patients (23 female, 9 male; mean age, 21.28 years; range, 16-31 years) with unilateral complete alveolar cleft after reconstructive surgery for cleft lip and palate (CLP). INTERVENTIONS: Harvested iliac crest bone was cut into 2 corticocancellous blocks. The smaller block was adapted against the sutured nasal mucoperiosteum and overlaid with cancellous bone; the larger one overlapped the labial cleft margin and was fixed with screws. Endosteal dental implants were placed after 4 to 6 months, and final restorations were delivered 6 months later. MAIN OUTCOME MEASURES: Flap statuses were assessed clinically. Bone formation was assessed using the Enemark scale. Cone-beam computed tomography was used for graft height and width measurements. Implant health was assessed by the Misch criteria. RESULTS: The mean postgrafting follow-up period was 36.7 ± 10.4 (range, 18-53) months. Three patients (9.4%) showed flap dehiscence but no infection 7 days after bone grafting. Twenty-nine patients (90.6%) had 75% to 100% bone fill (Enemark score of 1). The mean graft height and width were 11.4 ± 2.4 and 6.1 ± 1.0 mm, respectively. Sufficient bone for implant placement was noted in 29 patients (90.6%); the others required partially fixed prostheses. All implants functioned for at least 18 months. CONCLUSION: The proposed technique is reliable to reconstruct the alveolar cleft for implant placement in CLP patients.

Introduction of microsurgery in Vietnam by a charitable organization: a 15-year experience.

BACKGROUND: Microsurgical procedures, although equipment- and labor-intensive, allow efficient treatment of selected soft-tissue, bone, and peripheral nerve defects. The precise surgical skills required and the high equipment and institutional costs have been deterrents to initiating programs in developing countries. The authors report their 15-year international effort in facilitating the development of microsurgical techniques in Vietnam. METHODS: The authors reviewed their educational, logistical, and operative experience from 11 Operation Smile International missions to Vietnam and the microsurgical procedures performed independently by Vietnamese surgeons at the Central Military Hospital 108 in Hanoi. RESULTS: Over 15 years, Operation Smile International missions to Vietnam performed 108 free tissue transfer operations with 15 peripheral nerve transfer procedures and 143 nonmicrosurgical reconstructive operations. Visiting surgeons with specialized expertise taught facial reanimation, flap prefabrication, and perforator flaps. During this same period, Vietnamese surgeons became facile with microsurgical techniques and independently performed a wide array of these procedures in the institutions visited. Vietnamese surgeons have organized microsurgery divisions within some hospital departments and now teach microsurgical techniques. Repeated missions allowed for patient follow-up, staged procedures, educational exchange, and quality control. Several Vietnamese surgeons have traveled abroad to obtain additional training and have set up training programs in other areas of Vietnam. CONCLUSIONS: Charitable organizations can help surgeons in developing countries master complex microsurgical techniques through short-term medical missions, donation of equipment and supplies, and the encouragement of institutional support. A continuing education program, including local conferences, microsurgical laboratory training facilities, and study abroad, can aid this introduction.