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Simultaneous Closure of Alveolus and Hard Palate with Concomitant Bone Grafting

Kim, Erinn Noelani MD; Tuncer, Fatma Betul MD; Mehta, Sagar Tushar , MD; Yamashiro, Duane DDS; Siddiqi, Faizi MD; Gociman, Barbu MD, PhD

Plastic and Reconstructive Surgery – Global Open: July 2019 - Volume 7 - Issue 7S - p 3-4
doi: 10.1097/01.GOX.0000579804.79443.c0
Mountain West 2019 Abstract Supplement

University of Utah, Salt Lake City, UT

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

INTRODUCTION: Classical repair of the cleft hard palate involves closure of nasal and oral mucosa without bony reconstitution. However, lack of bony support can lead to collapse of the maxillary arch, dental crowding and posterior cross-bite. To avoid the above, our institution performs two staged repair of the cleft palate with placement of demineralized bone matrix (DBX) into the residual palatal defect to re-create normal palatal anatomy.

METHODS: A retrospective review of children who underwent a two stage palatoplasty from 2016–18 was performed. At our institution, the soft palate is closed around 9 months of age and the hard palate repair around 2–3 years of age. During the second stage, the alveolar cleft was exposed to achieve a concomitant closure of the alveolus and hard palate. DBX was placed into the alveolar cleft and hard palate. These patients’ records, images, and dental impressions were reviewed for complications and changes in maxillary morphology.

RESULTS: 12 patients had a two stage palatoplasty with bone grafting in the second stage. None of the patients developed infection, hematoma, dehiscence, airway obstruction or fistulas. Dental impressions revealed less palatal arching and widening of the maxilla. All patients had normal occlusion.

CONCLUSIONS: Our early results support that there is less collapse of lateral segments and a more stable dental arch in patients who underwent bone grafting at the time of cleft palate repair. Wide exposure during the repair allows complete grafting of the maxillary bony deficit, which is not possible with traditional alveolar cleft repair.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.