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Secondary bone grafting of alveolar clefts in the cleft lip and palate patient
British Journal of Oral and MaxillofaclacralSurgery (1998) 36, 220-238 0 1998 The British Association of Oral and Maxillofacial Surgeons
Abstracts of papers and postersfrom the 1998 BAOMS Meeting ABSTRACTS
OF PAPERS
The surgical correction of cleft palate in children of up to 1 year old. G. Gonchakov. Scientific-Practical Center for Children’s Medicine, Moscow, Russia.
A modified approach to Le Fort I osteotomies in patients with repaired cleft lip/palate. A. W Sugar, R. Samuels, M. 15. Jones, A. I? Bocca, C. Newton. Maxillofacial Unit, Morriston Hospital, Swansea, UK.
A cleft palate causes an anatomical disorder of palatal and nasopharyngedt tissue which leads to functional problems and negatively influences the child’s development. These changes are associated with atrophy of the soft palate muscles, hypertrophy of the tongue and disorder of the pharyngotympanic (Eustachian) tube’s normal function. These problems lead to functional difftculties in breathing, speech, hearing and nutrition. We include all types of cleft palate in our classification, taking into account the character and size of the cleft palate, the maxillary deformity and changes in the palatopharyngeal ring. This classification allows us to decide on a treatment strategy in the first days in the life of a child with cleft palate. Clinical observations confirm that the functional disorders improve after correction of the anatomical defect and support the speech pathologist’s future training. The important criteria for success are the timing of surgery, the type of surgery and the pre-existing paFdtopharyngea1 ring features. We will outline the stages of surgery which allow up to 12 months for the natural repair of the natural size and form of the soft and hard palate and will ensure functional rehabilitation. The surgery is in two stages for most cleft palates, except those involving the soft palate only. The two stages allow for a decrease in the hard palate defect without narrowing of the maxilla and the final closure of the hard palate is delayed until 12 months of age. The surgical flaps are raised 5-6 mm from the cleft margin, thereby decreasing the surgical insult to the maxillary bone and causing minimal trauma to the tooth germ system, ensuring as normal a growth development as possible. The plastic surgery to the soft palate with pharyngeal ring narrowing guarantees the early functional loading of the soft palate muscles, counteracts the hypertrophy of uvular muscles and ensures the correct environment for speech, breathing, hearing, growth and nutritional development. There is little interference in development of the tooth germ system. The second-stage repair of the remaining small hard palate defect avoids the crude manipulation of maxillary soft tissue with its harmful effects on growth development.
In 1990, we described’ a combined approach to the late management of cleft lip and palate problems. This included a Le Fort I osteotomy in which the surgical technique was modified. In this paper, we describe the overall approach and surgical technique with: 1. fixed band orthodontic preparation in every case; secondary alveolar bone grafting (tertiary if secondary was not carried out); 3. modified incision to improve the vascular pedicle for an anterior downfracture of a one-piece maxilla with plate protection of the palate and radical mobilization; 4. internal fixation with four A0 L-shaped 2 mm titanium mini-plates; 5. autogenous medial cortico-cancellous anterior iliac crest bone grafting of the anterior maxilla only. 2.
The paper is illustrated with examples from a prospective study of 25 consecutive cleft cases operated with this technique and the skeletal stability after a minimum of one year follow-up is reported.
Reference 1. Jones M L, Sugar A W. Late management palate problems: a joint orthodontic/surgical J R Coil Surg Edinb 1990; 35: 376386.
of cleft lip and approach.
Secondary hone grafting of alveolar clefts in the cleft lip and palate patient. R. W Kendrick, L. C. Newlands. Northern Ireland Regional Plastic & Maxillofacial Unit, The Ulster Hospital, Dundonald, Belfast, Northern Ireland. We present our experience of secondary bone grafting of the alveolar cleft in cleft lip and palate patients in Northern Ireland from 1987-1997, following the ‘Oslo technique’.’ All our patients are seen at a combined maxillofacial/plastic/orthodontic clinic and an additional feature of our practice has been to combine grafting with any necessary nasal revision surgery. Case notes, serial radiographs and orthodontic models of relevant patients were examined and several parameters assessed; preoperative orthodontic status and the degree of conformation to the Oslo criteria at inclusion for surgery; operatively, the method of graft harvest and if the procedure was combined with nasal surgery; postoperative complications, bone levels and orthodontic requirements and results, We conclude that the multidisciplinary approach to this problem is advantageous to both patients and clinicians and that we have achieved high levels of success in osseous, dental and cosmetic rehabilitation of these patients.
Mandibular Sunderland
setback: should Royal Hospital,
patients be given a choice? Sunderland, UK.
L. Stassen.
Mandibular setbacks can be achieved in many ways. This prospective study confines itself to three well-recognized methods - the sagittal split, an intraoral vertical subsigmoid and an extraoral vertical subsigmoid. Each technique has advantages and disadvantages but achieve the same final result. The surgeon usually makes the decision for the patient. Is this acceptable in the present climate of informed consent? Should we be giving the patients the opportunity to decide their possible complications, if different procedures can give the same final result? A prospective study was set up. asking patients to choose between the three options for mandibular setback procedures. An information sheet was drawn up to set out the procedures in a random fashion and explain the surgery, post-operative management and complications. The operations were demonstrated to the patients (models), Each patient was given the opportunity to read the information sheet, make their choice, date and sign the sheet. Patients were able to change their choice up to the day of surgery and all were asked some time following the surgery if they were happy with their choice or, if offered the choice again, they should take the same option,
Reference Bergland 0, Semb G, Abyholm F E. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J 1986; 23: 1755205. 220
Abstracts of papers and postersfrom the 1998 BAOMS Meeting ABSTRACTS
OF PAPERS
The surgical correction of cleft palate in children of up to 1 year old. G. Gonchakov. Scientific-Practical Center for Children’s Medicine, Moscow, Russia.
A modified approach to Le Fort I osteotomies in patients with repaired cleft lip/palate. A. W Sugar, R. Samuels, M. 15. Jones, A. I? Bocca, C. Newton. Maxillofacial Unit, Morriston Hospital, Swansea, UK.
A cleft palate causes an anatomical disorder of palatal and nasopharyngedt tissue which leads to functional problems and negatively influences the child’s development. These changes are associated with atrophy of the soft palate muscles, hypertrophy of the tongue and disorder of the pharyngotympanic (Eustachian) tube’s normal function. These problems lead to functional difftculties in breathing, speech, hearing and nutrition. We include all types of cleft palate in our classification, taking into account the character and size of the cleft palate, the maxillary deformity and changes in the palatopharyngeal ring. This classification allows us to decide on a treatment strategy in the first days in the life of a child with cleft palate. Clinical observations confirm that the functional disorders improve after correction of the anatomical defect and support the speech pathologist’s future training. The important criteria for success are the timing of surgery, the type of surgery and the pre-existing paFdtopharyngea1 ring features. We will outline the stages of surgery which allow up to 12 months for the natural repair of the natural size and form of the soft and hard palate and will ensure functional rehabilitation. The surgery is in two stages for most cleft palates, except those involving the soft palate only. The two stages allow for a decrease in the hard palate defect without narrowing of the maxilla and the final closure of the hard palate is delayed until 12 months of age. The surgical flaps are raised 5-6 mm from the cleft margin, thereby decreasing the surgical insult to the maxillary bone and causing minimal trauma to the tooth germ system, ensuring as normal a growth development as possible. The plastic surgery to the soft palate with pharyngeal ring narrowing guarantees the early functional loading of the soft palate muscles, counteracts the hypertrophy of uvular muscles and ensures the correct environment for speech, breathing, hearing, growth and nutritional development. There is little interference in development of the tooth germ system. The second-stage repair of the remaining small hard palate defect avoids the crude manipulation of maxillary soft tissue with its harmful effects on growth development.
In 1990, we described’ a combined approach to the late management of cleft lip and palate problems. This included a Le Fort I osteotomy in which the surgical technique was modified. In this paper, we describe the overall approach and surgical technique with: 1. fixed band orthodontic preparation in every case; secondary alveolar bone grafting (tertiary if secondary was not carried out); 3. modified incision to improve the vascular pedicle for an anterior downfracture of a one-piece maxilla with plate protection of the palate and radical mobilization; 4. internal fixation with four A0 L-shaped 2 mm titanium mini-plates; 5. autogenous medial cortico-cancellous anterior iliac crest bone grafting of the anterior maxilla only. 2.
The paper is illustrated with examples from a prospective study of 25 consecutive cleft cases operated with this technique and the skeletal stability after a minimum of one year follow-up is reported.
Reference 1. Jones M L, Sugar A W. Late management palate problems: a joint orthodontic/surgical J R Coil Surg Edinb 1990; 35: 376386.
of cleft lip and approach.
Secondary hone grafting of alveolar clefts in the cleft lip and palate patient. R. W Kendrick, L. C. Newlands. Northern Ireland Regional Plastic & Maxillofacial Unit, The Ulster Hospital, Dundonald, Belfast, Northern Ireland. We present our experience of secondary bone grafting of the alveolar cleft in cleft lip and palate patients in Northern Ireland from 1987-1997, following the ‘Oslo technique’.’ All our patients are seen at a combined maxillofacial/plastic/orthodontic clinic and an additional feature of our practice has been to combine grafting with any necessary nasal revision surgery. Case notes, serial radiographs and orthodontic models of relevant patients were examined and several parameters assessed; preoperative orthodontic status and the degree of conformation to the Oslo criteria at inclusion for surgery; operatively, the method of graft harvest and if the procedure was combined with nasal surgery; postoperative complications, bone levels and orthodontic requirements and results, We conclude that the multidisciplinary approach to this problem is advantageous to both patients and clinicians and that we have achieved high levels of success in osseous, dental and cosmetic rehabilitation of these patients.
Mandibular Sunderland
setback: should Royal Hospital,
patients be given a choice? Sunderland, UK.
L. Stassen.
Mandibular setbacks can be achieved in many ways. This prospective study confines itself to three well-recognized methods - the sagittal split, an intraoral vertical subsigmoid and an extraoral vertical subsigmoid. Each technique has advantages and disadvantages but achieve the same final result. The surgeon usually makes the decision for the patient. Is this acceptable in the present climate of informed consent? Should we be giving the patients the opportunity to decide their possible complications, if different procedures can give the same final result? A prospective study was set up. asking patients to choose between the three options for mandibular setback procedures. An information sheet was drawn up to set out the procedures in a random fashion and explain the surgery, post-operative management and complications. The operations were demonstrated to the patients (models), Each patient was given the opportunity to read the information sheet, make their choice, date and sign the sheet. Patients were able to change their choice up to the day of surgery and all were asked some time following the surgery if they were happy with their choice or, if offered the choice again, they should take the same option,
Reference Bergland 0, Semb G, Abyholm F E. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J 1986; 23: 1755205. 220