THE ONE-STAGE PREMAXILLARY REPOSITIONING AND BONE GRAFT ALVEOLOPLASTY IN BILATERAL ALVEOLAR CLEFT; A PRELIMINARY STUDY

Abstract

Background: The bilateral alveolar cleft associated with markedly prominent premaxillary segment always possessed a surgical challenge because of the paucity of local flaps for watertight closure and high bone graft alveoloplasty failure rate. The orthodontic workup alone to mold unrestricted growing premaxillary segment could not optimize its position with the unfavorable functional and aesthetic outcome. In addition, the repeated surgical intervention may add burden on patient suffering and affect maxillary growth rate.Objective: Evaluation of the premaxillary viability, position, bone graft stability, and early growth after simultaneous premaxillary repositioning and alveolar bone grafting in alveolar cleft patients. Patients & Methods: Seven patients aged between 6 and 11 years were subjected to perioperative orthodontic workups to optimize the position of the premaxilla for its surgical correction before bone grafting. Then, the simultaneous premaxillary repositioning and bone graft alveoloplasty technique was done. Surgical indications, contraindications with orthodontic role were evaluated and discussed. Results: This prospective clinical study presents the outcome of seven consecutive pediatric patients who complained of alveolar clefts with severe premaxillary segment protrusion. It was conducted during the period between 2014 and 2020 in the Plastic Surgery Department-Aswan University Hospitals. The results were assessed by clinical examination and cephalometric tracing for at least two years for evaluating the premaxillary position, functional outcome, upper jaw stability, and early growth affection. Conclusion This technique proved to be a safe procedure in appropriately selected patients. It can produce an early stable maxillary arch with good aesthetic results besides less surgical interventions. No relapse or significant complications were documented. Clinical relevance The treatment of wide bilateral cleft alveolus patients is still based on experience and expert opinions. This preliminary study deals with markedly protruded premaxilla with bilateral alveolar cleft by combined orthodontic and one-stage premaxillary repositioning with bone graft alveoloplasty. An extended study period assessment for midfacial and maxillary growth is necessary to continue until adulthood or beyond.