Treatment algorithm for bilateral alveolar cleft based on the position of the premaxilla and the width of the alveolar gap.

Abstract

The efficacy of conventional secondary bone grafting is limited in instances of a bilateral alveolar cleft with a wide cleft gap and malpositioning of the premaxilla. The purpose of this study is to suggest a systematic algorithm to guide individualised treatment of a bilateral alveolar cleft according to the position of the premaxilla and the width of the alveolar gap. A total of 51 patients with bilateral alveolar clefts were investigated between January 2000 and February 2008. The average age was 9.2 years, and the mean follow-up period was 47 months. Conventional alveolar bone grafting (ABG) was performed for patients with both a narrow cleft gap and acceptable position of the premaxilla. Patients with both a wide cleft gap and acceptable premaxilla position were initially managed by interdental distraction osteogenesis. Premaxilla repositioning was indicated in patients with both sagittally and/or vertically unfavoured positioning of the premaxilla. The extent of bone resorption following bone grafting was evaluated using the Abyhölm criteria. Of 102 grafts, 98 grafts (96.1%) showed satisfactory bony take (Grade I-II). Only four grafts (3.9%) exhibited a poor outcome, with more than 50% bony resorption (Grade III-IV). The average hospital stay was 5.7 days and no serious complications were observed. Our approach resulted in satisfactory surgical outcomes. This suggests the feasibility of a standardised approach for the correction of a bilateral alveolar cleft. Our algorithm should be helpful for systematic and coordinated team approaches to rectify bilateral alveolar clefts.