Cleft Defects Research Articles

Prosthetic Rehabilitation of an Unusually Self-Obturated Cleft Palate Defect in an Adult Edentulous Patient Living in a Remote Rural Area. A Clinical Report

Patients with unrepaired cleft palate defects still exist within remote rural areas. The prosthodontic rehabilitation of an adult edentulous cleft patient could be very demanding for treating maxillofacial prosthodontist, since most of them are edentulous, challenging the retention and the stability of the maxillary prosthesis. It is therefore highly important that cleft palate patients seek dental and prosthodontic care as early in their life as possible. In this report, an unusual case of a patient self-obturated cleft palate defect is presented. The patient’s self-made prosthesis was replaced by an appropriately fabricated pharyngeal obturator prosthesis in order to improve speech and swallowing.

Effectiveness and Pitfalls of Intraoral Distraction in Wide Alveolar Clefts: An Experience

Statement of the problemRestoration of alveolar cleft defects is both essential and challenging for the craniofacial team. The technique of distraction is useful in large alveolar clefts, especially after the failure of conventional grafting procedures. The study aimed to analyze the effectiveness and problems of an intraoral tooth-borne distraction device. Materials and methodsSince 2015, 16 patients with nonsyndromic clefts were operated on. Because the defect was large, a trifocal distraction appliance was designed wherein the distractor appliance was completely tooth-borne and incorporated 2 hyrax screws. All distraction devices were individualized according to the patients’ situation. The appliance was cemented intraoperatively, and a latent period of 1 week was allowed. The distraction was performed twice daily at the rate of 0.5 mm/day. Methods of data analysisSingle-institution prospective study. ResultsAll patients were treated with distraction strictly following the natural curve of the dental arch. CBCT was taken prior to surgery and after 8 months of the last activation to visualize bone formation. Only 2 patients needed additional bone grafting procedure to fill the residual defect. In these patients, the required bone was small and was harvested intraorally. A failure of gingivoperioplasty (dehiscence) was observed in 1 patient. Outcomes dataAll patients were treated with distraction strictly following the natural curve of the dental arch. The mean width of the alveolar cleft was found between 11 and 17 mm. CBCT was taken after 8 months of the last activation to visualize bone formation. The continuity of bone could be seen in the majority of cases. The area of the residual defect was found to be between 28.24 and 39.24 mm. ConclusionThe intraoral distraction appliance was successful in the closure of a large alveolar cleft with the 2 transport segments docking successfully. Thus, a hyrax expansion screw used as a distractor could bring about controlled bony transport with the desired directional vectors. Its exclusive tooth-borne usage minimizes the invasiveness of the procedure, and the simplicity of the appliance eliminates the need for costly distractors, making such therapy feasible for a greater number of patients. The intraoral distraction appliance can be used successfully for the controlled closure of large alveolar clefts.

OROFACIAL CLEFTING –AN EXTENSIVE REVIEW

Groove in the palatal vault makes an abnormal communication between oral and nasal cavity is known as oro-facial cleft. It is an uncommon presentation in day-to-day clinical practice. According to World Health Organization, children with the complaint of oro-facial clefts found to be high in India. Children are commonly suffering from functional and aesthetical problems due to Oro-facial clefting. Globally, an estimated 200,000 babies are born with a cleft lip, palate or both each year in the United States. Etiology may be congenital or acquired. Palatal and Alveolar cleft defects are the most common etiological factors. Cleft lip and cleft palate can sometimes develop in combination with a syndrome due to genetic causes. The acquired causes may be infections, trauma, postsurgical complications, neoplasms, periapical pathology, radio and chemo necrosis. Clinical features like defective speech, and upper respiratory tract and ear infections, fetid odor, bad taste, nasal regurgitation of food are the associated consequences of oro-nasal communication. Therefore, this malformation syndrome is an important public health problem. Many cleft palate and cleft lip develops due to the combination of genetic and environmental factors. There are more than 400 genes linked to formation of cleft lip and palate. Some environmental factors associated with cleft include medications, deficiency of folic acid, and cigarette, drugs or alcohol conception during pregnancy. In this article we review the anatomy, embryology, epidemiology clinical manifestations and treatment options of the oro-facial cleft
 Key words: Oro-facial Cleft, Classification, , Anatomy , Embryology, Morphology, Incidence, Congenital Anomaly

Repair of alveolar cleft bone defects in rabbits by active bone particles containing modified rhBMP-2.

Objective: A model of alveolar cleft phenotype was established in rabbits to evaluate the effect of active bone particles containing modified rhecombinant human BMP-2 on the repair of the alveolar cleft. Methods:2-month-oldJapanese white rabbits were selected and randomly divided into fourgroups: normal, control, material and BMP groups. Blood biochemical analysis, skull tomography (microfocus computerized tomography), and histological and immunohistochemical staining analysis of paraffin sections were performed 3 and 6months after operation. Results: Both types of collagen particles showed good biocompatibility andpromoted bone regeneration. The effect of active bone particles on bone repair and regeneration wasbetter than that of bone collagen particles. Conclusions: Active bone particles containing modified rhecombinant human BMP-2 can be usedfor incisors regeneration.

Prevalence of cleft lip and/or cleft palate in Guangdong province, China, 2015–2018: a spatio-temporal descriptive analysis

ObjectivesThis study aimed to investigate the temporal and spatial characteristics of cleft lip and/or palate based on a large-scale birth defect monitoring database.MethodsData on perinatal infants and children with cleft...

A spatial analysis of birth defects in Texas, 1999-2011.

The etiologies of major birth defects are still unclear and few spatial analyses have been conducted in the United States. Spatial analyses of individual-level data can help elucidate environmental and social risk factors. We used generalized additive models to analyze 52,955 cases of neural tube defects, congenital heart defects (CHDs), gastroschisis, and orofacial cleft defects, and sampled from 642,399 controls born between 1999 and 2011 in Texas. The effect of geographic location was measured using a bivariable smooth term of geocoded birth address within a logistic regression framework. We calculated and mapped odds ratios (ORs) and 95% confidence intervals (CIs) for birth defects subtypes across Texas, and adjusted for maternal characteristics, environmental indicators, and community-level covariates. We also performed time-stratified spatiotemporal analyses for more prevalent birth defects. Location was significantly associated with crude odds of all birth defects except hypoplastic left heart syndrome. After adjusting for maternal characteristics, environmental indicators, and community-level factors, ORs in many geographic areas were no longer statistically significant for most defects, especially CHDs. However, areas of significant and insignificant elevated risk remained for defects in all groups in North and South Texas, with ORs for ventricular septal defects increasing over time. Low risk of birth defects was often present in the northern part of East Texas. Significant spatial patterns of birth defects were identified and varied depending on adjustment of different categories of covariates. Further investigation of areas with increased risks may aid in our understanding of birth defects.

Presurgical nasoalveolar molding: an advantageous adjunctive neonatal therapy for cleft lip and palate defects in 2 clinical cases

The most common congenital craniofacial anomalies are labial-alveolo-palatal clefts. Infants with these deformities may have problems and limitations with breathing, feeding, speaking, hearing, as well as psychological problems. The treatment protocol for these patients is carried out using an interdisciplinary approach. Thus, in addition to surgical reconstruction, presurgical neonatal orthopedics have shown considerable advantages in the treatment of such malformations. Recently, presurgical nasoalveolar molding (PNAM) has been introduced to prevent nasal deformities, and to obtain a satisfactory surgical result and good psychological reintegration. This article describes, through 2 clinical cases, the technique of preparation of PNAMs, their surgical and clinical advantages, as well as the role of a multidisciplinary approach in effectively managing disorders related to labio-alveolo-palatal clefts.

Identification of differentially expressed proteins involved in fetal scarless wound healing using a rat model of cleft lip.

In early pregnancy, fetal skin wounds can heal quickly and undergo a transition period from scarless healing to scar formation. The aim of the present study was to identify potential biomarkers associated with scarless repair of cleft lips, in order to determine the intrinsic factors leading to scar formation in embryonic tissue. A stable model of cleft lip was established using microsurgery by constructing a wedge-shaped cleft lip-like defect in fetal rats at gestational age (GA) 16.5 and GA18.5. The GA16.5 and GA18.5 groups were used to model scarless healing and scar formation, respectively. The fetuses were returned to the uterus following surgery, then removed 72 h after the procedure. Macroscopic observation of the cleft defect and histological examination were carried out. Reverse transcription-quantitative (RT-q) PCR and parallel reaction monitoring (PRM) were used to detect mRNA and protein expression levels, respectively. The upper-left lip completely healed 72 h after surgery in the GA16.5 group of fetal rats. However, this was not the case in the GA18.5 group. Histological examination indicated new follicles visible under the epidermis of the scarless group (GA16.5). Scarring was visible on the upper-left cleft lip wound of the fetal rats in the GA18.5 group. The expression of some growth and pro-inflammatory factors, including TNF-α, were also different between two groups. Label-free quantification was used to identified differentially expressed proteins and five differentially expressed proteins (Smad4, Fabp5, S100a4, S100a8 and S100a9) were identified. The relative expression of these molecules at the mRNA and protein levels were measured using RT-qPCR and PRM. These molecules may represent potential biomarkers for the scarless repair of fetal rat cleft lip wounds.

Cephalometric analyses for cleft patients: a statistical approach to compare the variables of Delaire\u2019s craniofacial analysis to Bergen analysis

ObjectivesCephalometric analyses using lateral craniofacial radiographs are common diagnostic procedures for evaluating skeletal patterns. However, in patients with pronounced abnormalities like cleft lip and palate, standard cephalometric analyses and landmarks may not be suitable. This study aims to clarify whether the inclusion of landmarks less compromised by the cleft defect or located outside the cleft area results in a different cephalometric assessment of the viscerocranium. Delaire’s whole-skull analysis and Bergen analysis were examined for similarities and underlying common observations.Materials/methodsBased on the cephalometric evaluation of 217 patients with different types of non-syndromal cleft formation, Delaire and Bergen analysis were compared using three statistical methods: correlation analysis, factor analysis, and cluster analysis. Reproducibility was assessed by Bland–Altman plots, intraclass correlation coefficients, mean absolute differences, and coefficients of variability.ResultsAlthough Delaire analysis and Bergen analysis are based on different concepts and landmarks, a majority of corresponding variables was found. Certain aspects of craniofacial base relation and craniospinal articulation are only assessed by Delaire analysis. All but one variable showed very good reproducibility.ConclusionsThe inclusion of landmarks less compromised by or located outside the cleft area does not result in variables that provide a different assessment of the viscerocranial area.Clinical RelevanceThe findings contradict the concept of invalidity of landmarks compromised by the cleft defect or located within the affected cleft area. Within the scope of its viscerocranial field of view, Bergen analysis appears to be on a par with Delaire analysis in the diagnosis of cleft patients.

Evaluation of 3D computer-assisted patient’s specific scaffold seeded with autogenous stem cells and platelet-rich fibrin in alveolar cleft repair.

Purpose: Evaluation of the treatment outcome of using patient-specific implantable scaffolds seeded with autogenous bone marrow mononuclear cell layer containing stem cells and platelet-rich fibrin in the treatment of alveolar cleft defect. Materials and methods: 12 alveolar cleft defects were divided into 2 groups; group A, six alveolar defects were treated using 3D printed patient’s specific implantable PLLA scaffolds seeded with autogenous bone marrow mononuclear cell layer containing stem cells and platelet-rich fibrin. Group B, six alveolar defects were treated with standard anterior iliac crest cortico-cancellous alveolar bone grafting procedures. Clinical and radiographic assessments were done to compare between two groups. Results: The results Showed that after 6 months group A was radiographically significantly less dense than the autogenous grafting group and when compared to Bergland’s scale there was no significant difference in bone loss after 6 months. Conclusion: Although this technique may not be the best choice regarding the density of bone formation, however within the limitations of this study, the results showed that this technique may be a new solution for transformation of the persistent cases of chronic oronasal fistula patients who underwent multiple failed autogenous bone grafting from a state of chronic fistulation to normal alveolar bone augmentation candidates.

Revisional Techniques for Secondary Cleft Lip Deformities.

Secondary deformities of repaired cleft lips are an unfortunate complication despite the meticulous approach of modern primary procedures. Most of these surgeries take place in the patient's early life and must be strategically planned to provide optimal cosmesis with minimal interventions. Depending on the level of severity, treatment of the secondary deformities ranges from noninvasive or minimally invasive techniques to complete revision cheiloplasty. Many novel topical, injectable, and laser therapies have allotted physicians more technical flexibility in treating superficial distortions. Nonetheless, surgical techniques such as diamond excision and adjacent tissue transfer remain popular and useful reconstructive modalities. Deformities involving the orbicularis oris must be completely taken down to allow full access to the muscle. Complete revision cheiloplasty requires recreation of the cleft defect and reconstruction similar to the primary repair. Due to the myriad of presentations of these secondary deformities, familiarity with the various treatments available is imperative for any cleft surgeon.

Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate

Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2). Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2. In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.

Allogeneic Bone Application in Association with Platelet-Rich Plasma for Alveolar Bone Grafting of Cleft Palate Defects.

Aim:The aim of this study is to compare allogeneic bone grafts associated with platelet-rich plasma (ALBGs-PRP) to autogenous bone grafts (ATBGs) for alveolar reconstructions in patients with cleft lip and palate (CLP).Materials and Methods:The Maxillofacial Surgery Service of the Comprehensive Care Center for CLP (CCCLP) in Curitiba (Paraná, Brazil).Patients:Thirty out of 46 patients with 8–12 years of age and pre- or trans-foramen unilateral clefts were operated by the same surgeon. Groups were selected randomly after coin-toss for the first surgery to be ALBG-PRP.Interventions:Pre- and post-surgery cleft defect severity was registered by a score system using superimposed digitalized peri-apical radiographs. The hypothesis indicated ABG-PRP to be similar to the ABG was proved.Results:There was no statistically significant difference (P < 0.05) in bone augmentation for the ABG-PRP group (79.88%) when compared to the ABG group (79.9%).Conclusion:ABG-PRP is indicated as a successful treatment modality to reduce the need for additional donor sites and reduce morbidity and hospital stay.

Evaluation of Platelet Rich Fibrin Sandwiching technique with mixture of alloplastic bone graft and Hyaluronic Acid in repair of Recurrent Oronasal Fistula

Aim: is to evaluate efficacy of platelet rich fibrin (PRF) sandwiching technique associated with hyaluronic acid (HyA) mixed with alloplastic bone graft in closure of recurrent oronasal fistula after previously alveolar cleft grafting. Subjects and Methods: Our study conducted on 24 patients with recurrent unilateral oronasal fistula complaining of oronasal leakage. They were divided into two random equal groups. Group I, alveolar cleft defect was packed with alloplastic bone graft ( osteon II collagen) between two layers of PRF gel. While, in group II, alveolar cleft defect was packed with a mixture of alloplastic bone graft (osteon II collagen) and HyA between the two layers of PRF gel. All patients were observed clinically and radiographically (CBCT) for evaluation after three and six months postoperatively. Results: Our clinical results revealed that, all patients had uneventful wound healing except 4 cases in group I and one case in group II which had wound dehiscence and graft exposure at 1-week postoperatively. The radiographic results by CBCT scans showed a better new bone formation and good osseous union obliterating the oronasal defect.in group II than group I. There was a significant difference between bone density and bone resorption values in both groups at all intervals. Conclusion : Our results demonstrated that PRF sandwiching technique combined with a mixture of alloplastic bone graft and HyA could provide a favorable bony and soft tissue barriers for closure of recurrent oronasal fistula in alveolar cleft patients.

Lateral Meniscus Posterior Root Injury: MRI Findings in Children With Anterior Cruciate Ligament Tear.

BACKGROUND. Undiagnosed and unrepaired root tears are increasingly recognized as a preventable cause of accelerated osteoarthritis. Preoperative MRI findings of lateral meniscus posterior root tears in children with concomitant anterior cruciate ligament (ACL) injury are not well described. OBJECTIVE. The purpose of this study was to investigate the performance of preoperative MRI for identifying concomitant lateral meniscus posterior root injuries in pediatric patients with ACL tears with arthroscopy as the reference standard. METHODS. Consecutively registered children who underwent MRI within 90 days before arthroscopic primary ACL reconstruction between March 2017 and December 2019 were included. Two radiologists assessed MRI examinations for direct signs involving the root proper and for findings associated with lateral meniscus posterior root tears. Kappa coefficients for MRI findings were computed. Findings in patients with root tears and intact roots were compared by independent-samples t test, Mann-Whitney U test, chi-square test, Fisher exact test, and multivariable logistic regression analysis. RESULTS. At arthroscopy, 39 children (18 boys, 21 girls; mean age, 15.2 ± 1.4 years) had lateral meniscus posterior root tears; 51 (22 boys, 29 girls; mean age, 15.7 ± 1.8 years) had intact roots. Kappa coefficients ranged from 0.65 to 0.92, aside from tears involving the entheseal segment (κ = 0.55) or popliteomeniscal fascicles (κ = 0.45). MRI findings that were predictors of arthroscopically diagnosed root tear (p < .05) were lateral meniscus root tear in any segment (odds ratio [OR], 16.8; 95% CI, 5.6-50.1), degeneration in any segment (OR, 3.9; 95% CI, 1.6-9.6), coronal cleft sign (OR, 5.7; 95% CI, 2.0-16.7), sagittal ghost sign (OR, 4.8; 95% CI, 1.2-19.1), and axial radial defect sign (OR, 7.1; 95% CI, 2.4-20.5). Tear involving any segment of the root proper had the highest PPV, 82%, with 79% NPV. The coronal cleft, sagittal ghost, and axial radial defect signs had specificities of 88%, 94%, and 88% but sensitivities of 44%, 23%, and 49%. The only significant independent predictor on preoperative MRI was root tear in any segment (OR, 15.8; 95% CI, 2.7-137.5; p = .003). CONCLUSION. Among MRI findings evaluated for preoperative diagnosis of lateral meniscus posterior root tear, tear involving any segment of the root proper had the strongest performance; associated findings had high specificity but low sensitivity. CLINICAL IMPACT. Accurate identification of lateral meniscus posterior root tears on preoperative MRI can aid in operative planning and reduce treatment delay.

Closure of large alveolar defect by maxillary alveolar distraction using a vector-controlled distractor appliance in cleft patients: A pilot study

ObjectiveTo assess the treatment outcome of custom made maxillary transport distractor appliance for closure of large alveolar clefts. MethodA pilot study was conducted on 12 large alveolar cleft defects present in 11 non-syndromic cleft lip and palate patients (1 bilateral and 10 unilateral) in the age group of 16–25 years. All the subjects underwent pre-surgical orthodontics followed by alveolar distraction using custom-made distractor appliance. Study models, lateral cephalogram, panoramic radiograph and cone beam computed tomograms were obtained pre-surgically (T0) and after distractor removal (T1). The reduction in the width and volume of the alveolar cleft defect and change in the mesiodistal axial inclination of the teeth in transport segment following distraction were recorded. P value ​< ​0.05 was considered statistically significant. ResultsSignificant reduction in cleft width (9.18 ​mm), volume (89.82 ​mm3) and the change in the mesiodistal axial inclination of the teeth in the transport segment (3.05°) (P ​< ​0.05) were observed. SNA (1.75°), ANB (1.58°), maxillary length (1.58 ​mm), upper incisor inclination (3°) and distal movement of anchorage teeth (0.95 ​mm) also showed significant change (P ​< ​0.05). ConclusionThe custom-made tooth borne distraction appliance successfully closed the large alveolar cleft defect with minimal or no inadvertent effects on the oral tissues.

The Medial Femoral Condyle Free Flap for Reconstruction of Recalcitrant Defects in the Head and Neck.

Small recalcitrant defects of the mandible and maxilla may be secondary to tumor, trauma, infection, and congenital origin. Vascularized bone grafting has been shown to effectively manage these defects; however, donor sites are limited. The vascularized medial femoral condyle (MFC) provides adequate cortical cancellous bone with the option of a skin island, consistent anatomy, and minimal donor site morbidity. This article outlines the use of the MFC flap for maxillomandibular reconstruction. A retrospective chart review of patients who required segmental maxillomandibular reconstruction with the MFC flap was conducted. A total of 9 patients (5 men and 5 women) with an average age of 45.3 years were identified. The etiology of the defects, flap sizes, and postoperative outcomes were recorded. Three patients had osteoradionecrosis of the neomandible after irradiation of the free fibula reconstruction, 3 patients had defects after cancer extirpation (1 mandible, 2 maxillary), 1 patient had a maxillary defect from trauma, and 2 patients had a residual cleft palate defect. All defects failed initial treatment with nonvascularized bone grafts. The average dimensions of the MFC flaps were 1.2 × 2.5 × 4 cm. Two of 9 flaps included a skin island. Eight flaps survived completely, but 1 patient suffered from flap failure requiring debridement and resulted in an oroantral fistula. Four patients received endosseous dental implants. Average time to union was 6.7 months, and average time to implant was 6.75 months. The average follow-up time was 24.9 months. The MFC flap is useful in the reconstruction of small segmental maxillomandibular defects and for the salvage of a neomandible after osteoradionecrosis. The MFC flap provides a reliable platform for endosseous dental implants and serves as an alternative source of vascularized bone reconstruction in the head and neck.

Does the Initial Width of Cleft Lip Play a Role in the Occurrence of Immediate Local Complications Following Primary Cleft Lip Repairs?

Among the several factors implicated in the occurrence of local surgical site complications following cleft lip repair is the initial width of the cleft. The aim of the study was to examine the effect of cleft width in the occurrence of immediate local surgical site complications. All consecutive subjects with diagnosis of unilateral or bilateral cleft lip with or without cleft palate who presented at the cleft clinic and satisfied the inclusion criteria were recruited in the study. The width of the cleft lip defect as adopted for the study was measured from the peak of the Cupid bow on the non-cleft side to a point where the white roll begins to thin out on the cleft side. Measurement was done using a Vernier Calliper. Surgery was performed under general anesthesia after which subjects were evaluated for the presence or absence of immediate local surgical site complications which included dehiscence, infection, and vermillion notching of the lip. A total of 70 subjects consisting of 36 (51.4%) males and 34 (48.6%) females were included in the study. Mean age (±SD) was 9.0 ± (19.4) months with age range of 3 months to 13 years. The prevalence of early surgical site complications was 24.3%. The width of cleft above a critical level (14 mm) statistically correlate significantly with the occurrence of early surgical site complications (P = 0.048). This study showed that the width of cleft lip of and above critical level of 14 mm may be associated with a clinically significant risk of immediate local surgical site complications.

Maternal Smoking Leads to Larger Cleft Palate Defects

Background: Oral clefts are birth defects that affect 500–1,000 livebirths depending on the geographic area. Maternal smoking increases the risk of stillbirths, prematurity, low birth weight, and oral clefts.Methods: In this case series, we measured the cleft palate defect of 10 children born from mothers who smoked during pregnancy and compared with measurements of 36 children born from mothers who did not smoke.Results: Palate defects tended to be larger in the group that the mother smoked during pregnancy.Conclusion: Smoking during pregnancy aggravates the size of the cleft defect in the palate.

The effectiveness of mineralized plasmatic matrix in the closure of alveolar clefts with volumetric assessment.

Objectives: The purpose of this study is to assess the effectiveness of mineralized plasmatic matrix in the soft tissue closure of naso-alveolar fistula, to estimate the postoperative bone fill and volume of the graft placed in the alveolar cleft defect using cone-beam computed tomography (CBCT) at 3rd- month and 6th- month. Material and methods: 10 patients, in the age group of 15‑30 years were included in this study. They were diagnosed with unilateral cleft lip and alveolus defects with or without a cleft palate requiring late secondary alveolar bone grafting. Alveolar cleft defects were closed with mineralized plasmatic matrix (MPM), a combination of autogenous iliac bone graft and platelet rich plasma (PRP) and platelet rich fibrin (PRF). Results: The mean defect volume pre-operatively is 0.75 cm3 and at the end of 3rd-month postoperatively is 0.51 cm3 and at 6th-month postoperatively is 0.27 cm3. The average percentage of bone fill between preoperative (A) & 3th- month postoperatively (B) is 33.4% and between 3rd-month (B) and 6th-month post operatively (C) is 49.5%. Conclusions: Utilization of this new matrix (MPM), has shown to be effective in the closure of the cleft defect, oro-nasal fistula and also reduction in the volume of the residual cleft defect seen with sequential cone-beam computed tomography (CBCT) radiographs.