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A radiographic comparison of the cranial base in patients with craniosynostosis
BRITISH JOURNAL OF PLASTIC SURGERY
362
Bone grafting in the cleft maxilla K. W. L. VIG and R. J. FONESCA School of Dentistry, University of Michigan, Ann Arbor, USA
Alveolar bone grafting in patients with cleft lip and/or palate is a well-established method of treatment. Autologous bone grafting, although widely accepted, has the associated morbidity of a second operative site from which the donor bone is harvested. An alternative is the use of allogeneic bone, which has been the preferred method of alveolar bone grafting since 1985 at the University of Michigan Medical Center, Ann Arbor, USA. The orthodontic implications and management of post-surgical movement of teeth into the grafted area were evaluated in 24 patients who had unilateral complete clefts of the lip and palate. The age of the patients ranged from 9-16 years, with a mean age at the time of surgery of 12.3 years, Radiographic and clinical data were available preoperatively, postoperatively and at long-term follow-up which ranged from 20-47 months. All patients had allogeneic bone chips grafted into the cleft and, pre-surgically, 21 patients had an associated oronasal fistula. The results from this retrospective study indicated that 10 of the patients in which the permanent canine was unerupted showed spontaneous movement into the grafted area with eruption of the canine. Those patients in whom the canine was already partially or fully erupted at the time of
Factors influencing deformed child
alveolar cleft grafting had the canine moved into the graft with orthodontic appliances. Of the 24 patients evaluated, 19 had pre-surgical orthodontic treatment which invariably included palatal expansion, and 23 had orthodontic treatment postsurgically. The presence of dehiscence and bone spicules from the surgical site occurred in 18 patients although none became infected. The oronasal fistula was closed at the time of surgery and remained closed except in two patients. Radiographic evaluation to determine bony bridging of the cleft site was achieved in 21 of the cases. The preliminary findings from this study indicate that all the criteria for success were not fully satisfied. The absence of morbidity from a second surgical site with allogeneic bone grafting may become the preferred treatment in the future. However, clinicians should be cautious in recommending this treatment until long-term results are available. Alternative treatment methods of grafting the cleft maxilla, with autogenous or allogeneic bone, poses a decision analytical problem with respect to utility. Ideally, a case-control study should be designed to determine relative efficacy and to provide probability estimates of the various treatment outcomes with each option.
the ability of families to cope with a craniofacially
E. WALTERS Park Hospital for Children, Oxford
In an attempt to understand what factors may influence the development of self-esteem in children born with craniofacial deformity, the parents’ coping ability of 22 families with children under 5 years presenting for craniofacial surgery was rated clinically following a preoperative semi-structured interview. The families were then divided into coping and non-coping groups. Detailed informa-
tion was gathered regarding demographic features, factors relating to chronic illness, factors specific to craniofacial disorder, potentially compounding stresses, parents’ attitute to surgery and satisfaction with services. There were 11 families in both the coping and non-coping groups. Comparing them showed no significant differences regarding the child’s age,
362
Bone grafting in the cleft maxilla K. W. L. VIG and R. J. FONESCA School of Dentistry, University of Michigan, Ann Arbor, USA
Alveolar bone grafting in patients with cleft lip and/or palate is a well-established method of treatment. Autologous bone grafting, although widely accepted, has the associated morbidity of a second operative site from which the donor bone is harvested. An alternative is the use of allogeneic bone, which has been the preferred method of alveolar bone grafting since 1985 at the University of Michigan Medical Center, Ann Arbor, USA. The orthodontic implications and management of post-surgical movement of teeth into the grafted area were evaluated in 24 patients who had unilateral complete clefts of the lip and palate. The age of the patients ranged from 9-16 years, with a mean age at the time of surgery of 12.3 years, Radiographic and clinical data were available preoperatively, postoperatively and at long-term follow-up which ranged from 20-47 months. All patients had allogeneic bone chips grafted into the cleft and, pre-surgically, 21 patients had an associated oronasal fistula. The results from this retrospective study indicated that 10 of the patients in which the permanent canine was unerupted showed spontaneous movement into the grafted area with eruption of the canine. Those patients in whom the canine was already partially or fully erupted at the time of
Factors influencing deformed child
alveolar cleft grafting had the canine moved into the graft with orthodontic appliances. Of the 24 patients evaluated, 19 had pre-surgical orthodontic treatment which invariably included palatal expansion, and 23 had orthodontic treatment postsurgically. The presence of dehiscence and bone spicules from the surgical site occurred in 18 patients although none became infected. The oronasal fistula was closed at the time of surgery and remained closed except in two patients. Radiographic evaluation to determine bony bridging of the cleft site was achieved in 21 of the cases. The preliminary findings from this study indicate that all the criteria for success were not fully satisfied. The absence of morbidity from a second surgical site with allogeneic bone grafting may become the preferred treatment in the future. However, clinicians should be cautious in recommending this treatment until long-term results are available. Alternative treatment methods of grafting the cleft maxilla, with autogenous or allogeneic bone, poses a decision analytical problem with respect to utility. Ideally, a case-control study should be designed to determine relative efficacy and to provide probability estimates of the various treatment outcomes with each option.
the ability of families to cope with a craniofacially
E. WALTERS Park Hospital for Children, Oxford
In an attempt to understand what factors may influence the development of self-esteem in children born with craniofacial deformity, the parents’ coping ability of 22 families with children under 5 years presenting for craniofacial surgery was rated clinically following a preoperative semi-structured interview. The families were then divided into coping and non-coping groups. Detailed informa-
tion was gathered regarding demographic features, factors relating to chronic illness, factors specific to craniofacial disorder, potentially compounding stresses, parents’ attitute to surgery and satisfaction with services. There were 11 families in both the coping and non-coping groups. Comparing them showed no significant differences regarding the child’s age,