Research On Repairing Alveolar Cleft With Autotransplantation Of Granular Iliac Bone

Objective: To study the surgical method and result of repairing alveolar cleft with autotransplantation of granular iliac bone and the factors which are able to influence the result of bone grafting and to discuss clinical results of repairing cleft lip nose deformity with bone grafting and iliac crest cartilage support simultaneously.Methods: 37 patients with the need of alveolar cleft bone graft at the age of 8 to 19 years,was selected in our department.Before operation cone beam computed tomography(CBCT)was taken for estimating the volume of the bone defect in alveolar cleft.And 5 linear measurement items on the lip and nose were measured,namely upper lip height,lip width(free edge),nostrils width,nostrils height and alar base width.Autogenous iliac cancellous bone was taken as graininess in the surgery to be free grafted into the alveolar cleft.Then we closed alveolar cleft and oroantral fistula.Obvious scar was removed on the upper lip.Iliac crest cartilage after carved was filled into the nasal dorsum,columella and ala nasi to play a supportive role and improve cleft lip nasal deformity.All the patients were followed up after 3 months to 2 years,taken cone beam computed tomography(CBCT)again and estimated the volume of the new bone in the graft area.We observed the wound healing,the eruption of the canine and nose deformity improvement,then measured 5 linear measurement items on the lip and nose.We explored the relationship between postoperative clinical results and the type of cleft,surgical age,type of surgery by applying SPSS 19.0 software for statistical analysis.And we discussed the improvement of the situation of cleft lip nose deformity with alveolar cleft bone graft for repairing nose deformity simultaneously.Results:(1)All the wound of 37 patients were healed by first intention in the oral bone graft area,no complications such as incision infection,wound dehiscence,or implanted bone being dischargeed.There was only one case of wound dehiscence in 37 cases of donor site incision at one week postoperative.The rest of the wound were healed by first intention,no complications such as infection,wound dehiscence,orinflammation that showing swelling and exudation.There were no pain in the wound of iliac crest,normal walking,no limp at 1 year postoperative.(2)37 cases of patients with alveolar cleft had repaired oroantral fistula.During the postoperative follow-up we observed that the fistula was completely closed,no conditions such as oroantral fistula recurrence or food reflux into the nasal cavity.(3)37 cases of patients(7 cases of patients with bilateral cleft alveolar)that needed cleft alveolar bone graft had 34 canines unerupted before surgery.At one year postoperative,we can see from bone graft area 19 canines were completely erupted,(accounting for 55.88%);10 part erupted(accounting for 29.41%);5 not erupted(accounting for 14.71%).(4)The clinical success rate of 44 sides of alveolar cleft bone graft was 61.4%.The clinical success rate in the group of patients between 8 and 12 years old,or unilateral cleft group,or simple type of surgery group was higher than that in other groups.(5)The difference of value between ipsilateral and contralateral side of the upper lip height,lip width(free edge),nostrils width,nostrils height and alar base width after alveolar cleft bone graft as well as repairing cleft and nose deformity simultaneously,was lower than the preoperative difference of value.That means the face tends to be more symmetrical.Conclusions:(1)Granular iliac cancellous bone as source for bone of alveolar cleft bone graft has good postoperative results and fewer complications.(2)Tension-free suturing wound in bone graft area is an important part of alveolar cleft bone graft successfully.(3)The most appropriate age of repairing alveolar cleft with autotransplantation of granular iliac bone is mixed dentition(9~11 years old).(4)The clinical success rate of alveolar cleft bone graft is related to the type of cleft,surgical age,type of surgery and so on.(5)The alveolar cleft bone graft and iliac crest cartilage transplanting for repairing nose and lip deformity simultaneously,can effectively improve the situation of the ipsilateral ala nasi and nasal floor collapse.It has advantages: less damage,less the number of surgery,postoperative satisfied appearance and so on.