Closure of a large alveolar cleft by bony transport of a posterior segment using orthodontic archwires attached to bone: Report of a case

Abstract

Secondary alveolar bone grafts performed during the mixed dentition stage of development of a child with a cleft lip and palate are useful surgical interventions for 1) providing bony continuity between cleft segments, 2) filling alveolar bony defects, 3) closing fistulae, 4) restoring nasal form, and 5) providing a bed of bone for permanent canine or lateral incisor eruption or orthodontic tooth movement. 1 Boyne PJ Sands NR Secondary bone grafting of residual alveolar clefts. J Oral Surg. 1972; 30: 87 PubMed Google Scholar , 2 Abyholm FE Bergland O Semb G Secondary bone grafting of alveolar clefts. Scand J Plast Reconstr Surg. 1981; 15: 15 Crossref PubMed Scopus (30) Google Scholar The timing of treatment and size and anatomy of the cleft can determine the treatment options and clinical outcomes. Unusually wide clefts are difficult to graft and are frequently associated with large palatal fistulae that may persist after orthodontic expansion and bone grafting. Although segmental osteotomies have been used to anteriorly reposition the lesser segment, 3 Posnick JC Witzel MA Dagys AP Management of jaw deformities in the cleft patient. in: Multidisciplinary Management of Cleft Lip and Palate. Saunders, Philadelphia, PA1990: 530-542 Google Scholar , 4 Wolford LM Cottrell DA End-stage reconstruction in the complex cleft liop/palate patient. in: Facial Clefts and Craniosynostosis. Saunders, Philadelphia, PA1996: 504-536 Google Scholar large segmental movements can compromise the flap closure and the blood supply to the osteotomized segment. If the cleft and fistula are too wide to close surgically, then the patient is often treated with a dental prosthesis. We present a case in which a large cleft was closed by transport osteogenesis using an appliance constructed from orthodontic wires.