Evaluation Of Loss Of The Vestibular Sulcus After Repairing Bilateral Alveolar Clefts With Bone Graft In Different Soft Tissues Closure

Objective:The objective of this study is to observe the change of vestibular sulcus depth in bilateral alveolar cleft patients after secondary bone grafting using different surgical techniques(bucket-handle flap,bilateral mucosal flap and bilateral mucosal flap with premaxillary separation and bone grafting.Methods:The subject were forty two patients with bilateral alveolar cleft who had secondary alveolar bone grafting using different surgical techniques in the department of oral and maxillofacial surgery of Xiang Ya hospital, Central South University,three patients have bilateral alveolar cleft with complete bilateral cleft lip and thirty nine patients have complete bilateral cleft lip and palate.The depth of the sulcus assessed with the following grades:Grade 0,no change in the depth of the vestibular sulcus;GradeⅠ,loss about one third of the vestibular sulcus;GradeⅡ,loss about two thirds of the vestibular sulcus and GradeⅢ,the vestibular sulcus disappeared.Results:The bilateral mucosal flap was used to cover grafted bone in 36 patients;bucket handle flap was used to cover grafted bone in 3 patients and bilateral mucosal flap with vomer resection used to cover grafted bone in 3 patients.Grade 0,in twenty patients(47.6%);GradeⅠ,in 10 patients(23.8%); GradeⅡ,in ten patients(23.8%);and gradeⅢ,in two patients(4.7%). The patients that the vestibular sulcus depth assessed as gradeⅡ,two of them were treated by using bucket handle mucosal flap and another two patients were treated by using bilateral mucosal flap with vomer resection.The patients that the vestibular sulcus depth assessed as gradeⅢ,one patient was treated by bucket handle mucosal flap and one patient was treated by using bilateral mucosal flap with vomer resection. So,the results of bilateral mucosal flap associated with vomer resection were similar to the results of bucket handle mucosal flap of the upper lip. Conclusion:In this study,we described the effect of different surgical methods for alveolar bone graft of cleft alveolus on the depth of vestibular sulcus.We observed that the buccal mucosal flap will give tension free oral lining and has minimal affect on the vestibular sulcus depth.While the handle bucket flap and buccal mucosal flap with vomer resection will reduce the depth of the vestibular sulcus.Therefore,the surgeons must consider these complications and avoid them during operative design and operation. The article clinically describes the management for maxillary bone during the operation for bilateral cleft lip and palate,the optimal time for repair of maxilla,the principles and popular method for operating. Bilateral cleft lip and palate deformity is one of the most serious deformities in the maxillofacial malformation.If the deformity was not repaired or managed it will get more complications:1.Unilateral or bilateral cleft alveolus extending to the palate and teeth.2.Teeth adjacent to the cleft will be malaligned due to the lack of bony support.3.Rhinnorhea and tooth displacement will affect the oral hygiene4.Maxillary protrusion will influence the prosthetic rehabilitation.5.The rhinnorhea and protrusion in the maxillary arch affect the pronunciation.Surgeons have done a lot of research about secondary repair of bilateral cleft lip and palate and gain a lot of clinical experiences.This article will review methods,principles,time of bone grafting and orthodontic.Management of anterior maxillary boneThe type and the time of cleft lip repair has significant affect on the facial growth development,the range of the dissection and the quantity of tissue mobilization it will influence the quantity of scar at neonatal period.So extensive scar area it will inhibit the growth and development of maxilla.The type of cleft repair depends on the width of the cleft,edge of the lip,the quantity of surrounding tissue height of the upper lip.At past the surgeons during the bilateral cleft repair separate the vomer to facilitate repair of cleft lip.Recently it has been proved that during the operation of young age(＜5 years old)will cause facial deformity including hypoplasia in the mid face,the nose and the upper lip has no enough support,the emerge of mandibular arch is interfered by the malocclusion and lack of mastication force.Recently surgeons make osteotomy of the...