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At least 307 records · Page 17Linked to original sources
PubMed1999

Transoral maxillary distraction osteogenesis of an unrepaired bilateral alveolar cleft.

Distraction osteogenesis has gained acceptance as a viable modality for lengthening hypoplastic skeletal structures in the maxillofacial region. A case of the application of this technique to advance the maxilla in an unrepaired bilateral alveolar cleft via a transoral approach is presented. The distraction devices were applied bilaterally to the zygomatic buttress region with the activating arms protruding from the oral cavity. A high Le Fort I osteotomy was performed under general anesthesia and, prior to distraction, the three maxillary segments were unified with an occlusal acrylic splint. Activation was begun 6 days after placement, at a rate of 1 mm per day, until the planned maxillary advancement had been achieved. An 8-week period of consolidation was allowed prior to removal of the devices.

Alveoloplasty↗
PubMed2000

A rat model of gingivoperiosteoplasty.

The ability to avoid a subsequent bone graft makes the use of gingivoperiosteoplasty (GPP) at the time of cleft lip repair an attractive technique. The use of GPP, in combination with presurgical orthodontics, has been shown to result in successful bony union in the majority of patients. However, secondary bone grafting is still necessary in 30% to 40% of patients due to persistent alveolar bony defects. The elucidation of methods to improve the success rates of these procedures has been hampered by the lack of reproducible animal models. The purpose of this study was, therefore, to develop a rodent model of GPP that would facilitate the investigation of methods to improve osteogenesis in alveolar defects. We report a surgically produced rat model (9 x 5 x 3-mm alveolar defect) that is reproducible, inexpensive (relative to large-animal models), and simple technically. In addition, healing in this model occurs in a predictable manner during a 12-week period, thus enabling analysis of methods designed to accelerate or facilitate osseous regeneration.

Alveolar Process↗
PubMed2000

Correction of the bilateral cleft using the sliding sulcus technique.

The morphology of the bilateral cleft lip can be understood in terms of process theory and field theory. The former holds that an initial event sets in motion processes of division, deficiency, displacement, and distortion; these act on the cleft site to convert a trivial defect into the final result seen at birth. Field theory describes embryonic units that are in disarray by virtue of the cleft. A subperiosteal technique is described that combines these concepts to achieve simultaneous closure of the lip and alveolus. Primary separation of the nasal tip from the philtral-columellar unit is carried out along embryonic fusion lines.

Aged↗
PubMed2002

Regenerative treatment of serious periodontosis with grafting of cancellous iliac bone and gingival flaps and replanting of patients' teeth.

The purpose of this study was to assess the ability of serious periodontosis patients to regain satisfactory biting function, using the patients' own teeth, by regeneration of the alveolar bone. Twelve serious periodontosis patients whose alveolar bone was markedly absorbed and whose teeth were quite unstable were treated with replanting of their teeth and grafting of cancellous iliac bone and gingival flaps by the clinical team, which consisted of plastic surgeons and dentists. No patients developed postoperative complications (e.g., infections), and grafted iliac bone took in all patients. The total number of replanted teeth was 65, and only 4 of them fell off (92% take rate). Three to 4 months after surgery, the replanted teeth received prosthetic treatment so that the patients could begin biting. Ten patients were monitored for 5 months or longer, and they started to eat normal food after the fifth month. Regained biting function and satisfaction of having food were almost the same as before the periodontosis became severe in these 10 patients. Regeneration of alveolar bone was confirmed in later radiographs. To date, the maximum follow-up period is 2 years and 8 months (average = 1 year and 6 months). All patients have good biting function, and there have been no findings of absorption of reconstructed alveolar bone or of the root of replanted teeth. This treatment method would be quite useful for patients with serious periodontosis.

Adult↗
PubMed2002

Cancellous bone grafting in alveolar cleft repair: new experience.

Bone grafting plays an important role in the dental rehabilitation of patients with alveolar cleft. During the period between 1993 and 2001, 12 patients with alveolar clefts have been treated in our clinic. Cancellous iliac bone grafts were used in all 12 patients. Seven patients had left and five patients had right complete unilateral cleft lip and complete cleft palate operations. All patients had palatal fistulas. The ages were between 4 and 18 years (mean age, 10.5 y). Seven of them were female (58.4%) and 5 were male (41.6%). All the cancellous grafts survived. Enough filling and the closure of the fistulas were achieved except one patient who had wound dehiscence and partial graft loss. The patients experienced a limp for 2 days (mean time) because of the donor site. This surgical procedure achieves successful results if it is used with the proper indication in suitable cases.

Adolescent↗
PubMed2003

Repair of bilateral cleft lip: review, revisions, and reflections.

Rarely does the appearance of a child with a repaired bilateral cleft lip compare favorably with that of a child with a repaired unilateral cleft lip. However, there has been a major change in operative strategy during the past decade, and as a result, the typical bilateral cleft nasolabial stigmata are no longer so obvious. The senior author restates the principles for correction of bilateral cleft lip and nasal deformity, and underscores the essential role of preoperative premaxillary positioning. He reviews his method of single-stage closure of the cleft primary palate, including three-dimensional adjustments based on predicted four-dimensional changes. Operative modifications are described for variations of bilateral cleft lip. The authors emphasize the surgeon's obligation for periodic assessment. In a consecutive series of 50 patients with repaired bilateral complete cleft lip/palate, the revision-rate was 33% as compared with 12.5% if the secondary palate is intact. No revisions were necessary for philtral size or columellar length. The authors propose that nasolabial appearance and speech are the priorities in habilitation of the child with bilateral cleft lip/palate rather than the traditional emphasis on maxillary growth.

Alveoloplasty↗
PubMed2005

Reduction of bone resorption by the application of fibrin glue in the reconstruction of the alveolar cleft.

A major complication in 30% to 75% of cases of surgical treatment of alveolar cleft is resorption of the bone graft. A treatment alternative is the application of fibrin glue, which has the capacity to favor the integration of the graft. The main objective of the study was to evaluate if the use of the fibrin glue reduces bone resorption when it is applied locally. The authors designed a randomized clinical trial. Patients were divided into two groups: group 1, fibrin glue; and group 2, control. Pre- and postoperative graft volume, bone density, bone quality (Lekholm and Zarb, and Norton and Gamble classifications), and postoperative complications were evaluated. The follow-up for all patients was 3 months after discharge. Twenty-seven patients were surgically treated, 13 in group 1 and 14 in group 2. Group 1 had increased graft volume compared with group 2 (64.32 cm v 21.70 cm; P < 0.0001). Bone density was higher in group 1 than in group 2 (396.57 v 245.68; P > 0.076). Bone quality was type 1, 2 and 3 and 4 in group 1. Resorption in group 2 was 62.26%; in group 1, it was 29.72% (P > 0.081). The observed complications were infection and dehiscence of sutures (P > 0.537). The authors conclude that the fibrin glue significantly diminishes bone resorption, allowing improved graft integration and quality.

Adolescent↗
PubMed2005

Donor site morbidity of rib graft harvesting in primary alveolar cleft bone grafting.

The use of the rib for primary alveolar cleft bone grafting offers one of the few donor sites for grafting under one year of age. Its use in 211 patients in an 11 year period revealed no morbidity other than a small donor scar. Rib grafting in infants differs significantly from that in teenagers and adults with minimal pain, no risk of pneumothorax when properly performed, and more than an adequate stock of bone for the alveolar defect.

Alveolar Process↗
PubMed2006

Usefulness of simultaneous pre-maxillary osteotomy and bone grafting in the bilateral clefts.

Bilateral cleft lip and palate patients sometimes accompany with mal-positioned premaxilla, which adversely affect the upper lip morphology, especially widened naso-labial angle as well as functional deteriorations such as speech impairment though the fistula in between the alveolar segments. Usefulness of simultaneous premaxillary osteotomy and bone grafting was tested in respect of grafted bone resorption rate and required bone volume. Between January, 2001 and December, 2003, seven patients (seven years and eight months to 16 years old; average 9.7 +/- 2.87, 2 females and 5 males) with complete bilateral cleft lip and palate patients were performed the simultaneous premaxillary osteotomy and bone grafting, whereas in the same period of between January, 2001 and December, 2003, four patients (seven years and 11 months to 11 years old; average 9.2 +/- 1.01, 4 female and 6 males) with complete bilateral alveolus in order to compare cancellous bone volumes to relatively milder and less-protruded premaxilla. The bone grafting was performed in two-stage manner as one side and later, the other side. The bone volume required for cleft packing was significantly lower in osteotomized cases compared to those of non-osteotomized (3.5 +/- 0.69 mL vs. 5.6 +/- 0.70 mL, P < 0.01). There were twenty for non-osteotomized cases (10 bilateral clefts) and fourteen osteotomized (7 bilateral clefts) were evaluated. Overall, majority of both groups demonstrated the grade I (10/20 for non-osteotomized, 12/14 for osteotomized group). There was significant lower bone resorption rate in osteotomized group compared to the non-osteotomized group (1.1 +/- 0.36, 1.7 +/- 0.75, osteotimized, non-osteotomized, respectively, P < 0.05). The simultaneous premaxillary osteotomy and bone grafting is beneficial over staged bone grafting in bilateral cleft cases in requiring bone chio volume and subsequent bone resorption rate. The meticulous dissection and re-location of the premaxilla improves the overall lip morphology.

Adolescent↗
PubMed2006

Assessment of cleft lip and palate patients treated with presurgical orthopedic correction and either primary bone grafts, gingivoperiosteoplasty, or without alveolar grafting procedures.

The effects of alveolar grafting on the development of the craniofacial complex have been reported by numerous investigators. The reported results vary in the literature from significant to very little impediment of maxillary growth. The present work evaluates and compares facial form at age six years in complete unilateral cleft lip and palate patients treated with presurgical orthopedic correction and primary reconstruction with (1) primary bone grafts (n = 14), (2) gingivoperiosteoplasty (n = II), or (3) without alveolar grafting procedures at the time of lip repair (n = 13). The cohort groups were analyzed with a one-way analysis of variance (ANOV A). Statistical analysis revealed significant differences between the three groups for only one of the 12 parameters analyzed. The primary bone grafted group demonstrated less vertical descent-of the anterior maxilla compared to the gingivoperiosteoplasty and non-grafted groups (P = .0027).

Alveoloplasty↗
PubMed1983

The use of cranial bone grafts in the closure of alveolar and anterior palatal clefts.

A method is described for harvesting cancellous bone from the diploic space. In our opinion, this is the material of choice for bone grafting alveolar clefts in the 7- to 11-year age group. The procedure could be performed at an earlier age if the maxillary segments are under orthopedic control and in proper alignment. Success of the procedure depends on proper orthodontic preparation of the maxillary segments and careful, complete closure of the soft tissues across the anterior palatal cleft, the nasal lining defect, and the anterior alveolus. Results have been encouraging in terms of bone formation, and tooth migration into the bone graft can be expected if there has been no damage to the dental sac. Closure of the alveolar defect at the time of the primary lip closure would preclude the eventual need for a bone graft, but it cannot be accomplished without early, precise alignment of the maxillary segments if extensive periosteal denudation is to be avoided. The age beyond which periosteal closure alone will be inadequate to provide sufficient bone formation and should be supplemented by a bone graft remains to be established.

Adolescent↗
PubMed1984

The relationship between lip pressure following lip repair and craniofacial growth: an experimental study in beagles.

In the present study with beagles, various states of lip pressure (decreased and increased) following surgical creation of the lip and palatal defects and subsequent lip repair were found to be significantly related to craniofacial growth aberrations and disproportions. These aberrations are discussed in terms of an imbalanced functional skeletal-soft-tissue matrix. Significantly elevated lip pressure following lip repair in group III animals was found to be more detrimental to craniofacial growth than decreased lip pressure resulting from the surgical creation of a defect left unrepaired. Results of the study present, for the first time, documented evidence of a significant relationship between lip pressure following lip repair and craniofacial growth. Caution should be employed in extending these conclusions to the clinical setting, yet the findings underscore the need for well-controlled clinical studies designed to assess the influence of cleft lip repair on craniofacial growth.

Alveoloplasty↗
PubMed1984

Early osteoplasty.

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Alveoloplasty↗
PubMed1989

Dental replacement resorption after bone grafting to the alveolar cleft.

In a review of 100 consecutively performed bone grafts to the alveolar cleft, replacement resorption was found in 7 teeth adjacent to the cleft. Damage to the periodontal tissues during surgery is considered to be the main cause of this complication: granulation tissue from the bone graft may have some influence. Treatment of the affected teeth eventually includes extraction or surgical removal. To minimize the risk for this complication, we suggest that bone grafting should be done when the canine (or lateral incisor) is in an early stage of eruption and that orthodontic uprighting of the medial incisor should be done after surgery.

Adolescent↗
PubMed1995

Free colon transfer for resurfacing large oral cavity defects.

Ideal reconstruction of the oral cavity includes a durable lining that is thin, supple, and innervated, and that provides a lubricated surface that facilitates deglutition and speech. This paper describes the use of free colon transfer for relining the oral cavity. In three patients, segments of transverse colon, split along the antimesenteric border, were transferred as free flaps on the middle colic vessels for large defects involving the alveolar ridge, buccal mucosa, floor of the mouth, tongue, and pharyngeal walls. All flaps were transferred successfully without adverse vascular events, abdominal complications, or oro-cutaneous fistulas. One flap was re-elevated 2 weeks postoperatively for additional mandibulectomy. Two patients received postoperative radiation therapy and another patient received planned preoperative radiotherapy. The mucosal surface of the colon flattens to provide a thin, smooth, supple oral lining that produces moderate mucus, coapts well to the convoluted surfaces of the defects, and is durable to mastication and denture wear. Mucosal biopsy 2 years postoperatively in the nonradiated flap reveals normal colon mucosa with abundant mucin-producing cells. Free colon transfer is a "functional" reconstruction of the oral lining. The donor tissue is abundant and capable of resurfacing large, convoluted oral cavity surfaces with a thin, supple, mucus-secreting tissue that allows unimpaired tongue mobility, swallowing, speech, and denture wear. Furthermore, the presence of nonirradiated, mucus-secreting cells provides an avenue to further augment mucin production by topical and systemic agents.

Alveoloplasty↗