The One-Stage Premaxillary Repositioning and Bone Graft Alveoloplasty in Bilateral Alveolar Cleft: A Preliminary Study

Document Type : Review Article

Authors

1 The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Aswan University,

2 The Department of Radiology, Faculty of Medicine, Aswan University.

3 The Department of Dentistry, Aswan University Hospitals, Aswan, Egypt

Abstract

This prospective clinical study is designed to present
seven consecutive cases with bilateral cleft lip and palate at
age of mixed dentition to be managed by simultaneous premaxilla
repositioning and bone grafting of their clefts at period
between 2014 and 2019 in Plastic Surgery Department, Aswan
University. Clinical and cephalometric radiography assessment
during follow-up period up to two years' post-operation to
evaluate premaxilla position, stability, anterior palatal growth.
Indications, contraindications and the pre- and post-operative
orthodontic role technique were defined and proved to be a
safe procedure. In properly selected patients, it can produce
early one-step stable maxillary arch with good aesthetic result.
No relapse or major complication were detected.
Background: The bilateral alveolar cleft associated with
markedly prominent premaxillary segment always possessed
a surgical challenge because of the paucity of local flaps for
watertight closure and high bone graft alveoloplasty failure
rate. The orthodontic workup alone to mold unrestricted
growing premaxillary segment could not optimize its position
with the unfavorable functional and aesthetic outcome. In
addition, the repeated surgical intervention may addon patient
suffering and affect maxillary growth rate.
Objective: Evaluation of the premaxillary viability, position,
bone graft stability, and early growth after simultaneous
premaxillary repositioning and alveolar bone grafting inalveolar
cleft patients.
Patients and Methods: Seven patients aged between 6
and 11 years were subjected to perioperative orthodontic
workups to optimize the position of the premaxilla for its
surgical correction before bone grafting. Then, the simultaneous
premaxillary repositioning and bone graft alveoloplasty technique
was done. Surgical indications, contraindications with
orthodontic role were evaluated and discussed.
Results: This prospective clinical study presents the
outcome of seven consecutive pediatric patients who complained
ofalveolar clefts with severe premaxillary segment
protrusion. It was conducted during the period between 2014
and 2020 in the Plastic Surgery Department, Aswan University
Hospitals. The results were assessed by clinical examination
and cephalometric tracing for at least two years for evaluating
the premaxillary position, functional outcome, upper jaw
stability, and early growth affection.
Conclusion: This technique proved to be a safe procedure
in appropriately selected patients. It can produce an early
stable maxillary arch with good aesthetic results besides less
265
surgical interventions. No relapse or significant complications
were documented.
Clinical Relevance The treatment of wide bilateral cleft
alveolus patients is still based on experience and expert
opinions. This preliminary study deals with markedly protruded
premaxilla with bilateral alveolar cleft by combined orthodontic
and one-stage premaxillary repositioning with bone graft
alveoloplasty. An extended study period assessment for midfacial
and maxillary growth is necessary.

Keywords

Main Subjects

References

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