Iliac Cancellous Bone Graft Research Articles

Effect of “platelet rich” fibrin with bone marrow aspirate on the regenerative capacity of alveolar bone grafting with iliac bone graft: A randomized controlled trial

Objectives of the Study: (1) To evaluate the effect of platelet-rich fibrin (PRF) with bone marrow aspirate on regenerative capacity in patients undergoing iliac bone grafting for secondary alveolar bone grafting. (2) and to compare it with group 2 where only bone marrow aspirate was used along with iliac bone graft in secondary alveolar bone grafting. Materials and Methods: A prospective study on patients with cleft alveolus, requiring bone grafting and reporting to our unit from October 2018 to October 2020 was included in this study. Group 1 (bone marrow aspirate with PRF along with cancellous iliac bone graft) and Group 2 (bone marrow aspirate concentrate and cancellous Iliac bone graft without PRF). Computerized tomography (CT) scan was done to assess the volume of defect at the following intervals: Pre-op, immediate post-op, and 12 months. The outcome is assessed using a CT scan by statistical analysis. Results: Mean cleft alveolus volume measured preoperatively in group 1 was 2.5cc, post-operatively measured immediately was 3.2cc, and 12 months post-operative was 2.2cc. Mean volume defect in group 2 is 2.3cc, post-operatively measured immediately was 2.6 cc, and 12 months post-operative was 1.9cc. The average resorption rate at immediate post-op to 12 months interval in group 1 was 25% and in group 2 was 30%. The overall percentage of regenerated bone in group 1 was 75% whereas in group 2 it was 70%. Conclusion: Platelet-rich fibrin in combination with bone marrow aspirate and autogenous bone was beneficial in improving the volume of newly formed bone in the reconstruction of the cleft defect and also results in greater osteogenic effect which increases new bone regeneration and better wound healing.

Functional Outcomes of Gap Non-Union Humerus Fractures Treated with Fibular Strut Graft, Iliac Crest Graft, and Locking Compression Plate.

The humeral shaft gap non-union treatment surgically after unsuccessful fixation is difficult. In this study, the functional outcome of unsuccessful fixation of humeral shaft gap non-unions using a locking compression plate (LCP), fibular strut graft, and iliac bone graft was evaluated. After taking ethical approval, we studied 10 patients with humeral shaft gap non-unions with unsuccessful surgical fixation treated with open reduction and internal fixation using LCP with fibular strut graft and iliac cancellous bone graft. The study duration was from January 2022-January 2024. The mean time from non-union was 7 months. Disabilities of the arm, shoulder, and hand (DASH) scores improved significantly from a pre-operative average of 59.2 ± 7.3 to a mean final score of 24.6 ± 4.8 reflecting a mean improvement of 34.6 with no complications. This study shows that LCP with fibular strut graft and iliac bone grafts is a good alternative for diaphyseal humerus gap non-union along with statistically significant improvement in functional outcome, with union seen in all cases. This construct augments biomechanical stability and good biological healing in these gap non-unions.

A Novel Technique for Repairing Alveolar Clefts: Computer-Assisted Design With Posterior of Mandible Block Bone Grafts

Objective: Iliac cancellous bone graft is the gold standard for the treatment of alveolar clefts. However, the resorption rate of iliac cancellous bone is generally high. In this study, the authors propose a new method for repairing alveolar clefts using block bone grafts in the posterior region of the mandibular molar and the anterior margin of the ascending branch. Methods: Ten patients with a diagnosis of unilateral or bilateral alveolar cleft were collected. Block bone grafting between the posterior mandibular molar region and the inner and outer oblique lines of the anterior margin of the ascending branch was used to treat the alveolar synostosis. Preoperative, 1-week postoperative, and 6-month postoperative multislice spiral computed tomography scans of the patients were collected and analyzed for preoperative design and postoperative graft bone morphology using computer-assisted software tools, which were also required to measure the changes in the bone tissue density in the posterior mandibular bone extraction area. Results: At 6 months postoperatively, the mean bone resorption rate of the posterior mandibular bone grafts for cleft alveolar processes was 33.96% ± 11.23%. Bone tissue density in the posterior mandibular bone grafting area recovered to near preoperative levels at 6 months postoperatively. Conclusion: The novel method of bone grafting for the cleft alveolar process used in this paper is really effective. Postoperative posterior mandibular bone extraction did not cause sequelae such as mandibular bone defects or poor morphology in the patients. Computer-assisted design and three-dimensional printing technology helped to improve intraoperative bone grafting accuracy and postoperative assessment.

Comprehensive three-dimensional cone beam computed tomography assessment unilateral alveolar cleft reconstruction using autologous iliac cancellous bone combined with deproteinized bovine bone: A clinical retrospective evaluation

Large-volume autologous iliac cancellous bone grafting for alveolar cleft may lead to undesirable bone resorption and susceptible donor-site morbidity, whereas the addition of deproteinized bovine bone (DBB) could optimize outcomes. This study aimed to evaluate the effectiveness of combining autologous iliac bone with DBB using three-dimensional cone beam computed tomography (3D-CBCT) for better analysis of bone generation than conventional evaluation methods. Thirty-six patients with unilateral alveolar cleft were assigned into two groups. Group A (n = 21) underwent autogenous cancellous bone graft harvested from the anterior iliac crests, while Group B (n = 15) received a composite of autogenous iliac cancellous bone and DBB. Patients in Group B displayed higher bone filling rates (P < 0.0001) and lower bone absorption rates (P < 0.001) than those in Group A at both 6 months and 1 year postoperatively. Additionally, there were directional differences in bone absorption within the bone grafts, with more absorption observed on the alveolar crest and palatal sides than that on the nasal and labial sides (P < 0.001). This study demonstrates that employing a combination of DBB and autologous bone in alveolar cleft repair achieves better outcomes of bone grafting.

Integrating Virtual Surgical Planning and 3D-Printed Tools with Iliac Bone Grafts for Orbital and Zygomatic Reconstruction in Hemifacial Microsomia Patients.

Hemifacial Microsomia (HFM) is the second most common congenital craniofacial malformation syndrome, and the complexity of HFM makes its treatment challenging. The present study aimed to introduce a new approach of utilization of virtual surgical planning (VSP) and 3D-printed surgical adjuncts for maxillofacial reconstruction. Five HFM patients were included in this study. All participants were provided with a full VSP, including the design of osteotomy lines, the design and fabrication of 3D-printed cutting guides, fixation plates, and titanium mesh for implantation. With the assistance of 3D-printed cutting guides and fixation plates, the orbital deformities were corrected, and a 3D-printed titanium mesh combined with iliac cancellous bone graft was applied to reconstruct the zygomatic arch. The surgical accuracy, effectiveness, and bone absorption rate were evaluated. All patients completed the entirely digital treatment process without experiencing severe complications. The surgical adjuncts were effective in aligning the movement of the bone segments with the surgical plan, resulting in mean 3D deviations (1.0681 ± 0.15 mm) and maximum 3D deviations (3.1127 ± 0.44 mm). The image fusion results showed that the patients' postoperative position of the maxilla, zygoma, and orbital rim was consistent with the virtual surgical plan, with only a slight increase in the area of bone grafting. The postoperative measurements showed significant improvement in the asymmetry indices of Er (AI of Er: from 17.91 ± 3.732 to 5.427 ± 1.389 mm, p = 0.0001) and FZ (AI of FZ: from 7.581 ± 1.435 to 4.070 ± 1.028 mm, p = 0.0009) points. In addition, the observed bone resorption rate at the 6-month follow-up across the five patients was 45.24% ± 3.13%. In conclusion, the application of VSP and 3D-printed surgical adjuncts demonstrates significant value in enhancing the precision and effectiveness of surgical treatments for HFM. A 3D-printed titanium mesh combined with iliac cancellous bone graft can be considered an ideal alternative for the reconstruction of the zygomatic arch.

Three-dimensional printed titanium mesh combined with iliac cancellous bone in the reconstruction of mandibular defects secondary to ameloblastoma resection

BackgroundThe reconstruction of large mandibular defects is a challenge, and free vascularized bone flaps are most commonly used. However, the precision and symmetry of this repair are deficient, and patients have a risk of vascular embolism, flap necrosis, and donor site complications. Therefore, to explore an ideal alternative in mandibular reconstruction with high surgical accuracy and low complications is indispensable.MethodsSeven patients with recurrent or large-scope ameloblastoma were enrolled in this study. All patients were provided with a fully digital treatment plan, including the design of osteotomy lines, surgical guides, and three-dimensional printed titanium mesh for implantation. With the assistance of surgical guide, ameloblastomas were resected, and custom 3D printed titanium mesh combined with posterior iliac bone harvest was used in mandibular reconstruction. A comparison was made between the discrepant surgical outcomes and the intended surgical plan, as well as the average three-dimensional deviation of the mandible before and after the surgery. At the same time, the resorption rate of the implanted bone was evaluated.ResultsAll patients completed the fully digital treatment process successfully without severe complications. Image fusion showed that the postoperative contour of the mandible was basically consistent with surgical planning, except for a slight increase in the inferior border of the affected side. The mean three-dimensional deviation of the mandible between the preoperative and postoperative periods was 0.78 ± 0.41 mm. The mean error between the intraoperative bone volume and the digital planning bone volume was 2.44%±2.10%. Furthermore, the bone resorption rates of the harvested graft 6 months later were 32.15%±6.95%.ConclusionsThe use of digital surgical planning and 3D-printed templates can assist surgeons in performing surgery precisely, and the 3D-printed titanium mesh implant can improve the patient’s facial symmetry. 3D printed titanium mesh combined with posterior iliac cancellous bone graft can be regarded as an ideal alternative in extensive mandibular reconstruction.

Effectiveness of iliac cancellous bone grafting in alveolar cleft repair and analysis of factors affecting it.

To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it. A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated. Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036). The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.

Clinical observation of concentrated growth factor (CGF) combined with iliac cancellous bone and composite bone material graft on postoperative osteogenesis and inflammation in the repair of extensive mandibular defects

PurposeTo evaluate the effects of concentrated growth factor (CGF), combined with a mixture of iliac cancellous and composite bone materials, on the repair of extensive mandibular defects. Patients and MethodsThis clinical trial involved patients with mandibular defects caused by large cystic lesions. The test group comprised 16 patients who underwent CGF combined with iliac cancellous bone and composite bone materials to repair extensive mandibular defects, whereas the control group comprised eight patients who underwent vascularised free fibula grafts for mandibular segmental defects. Postoperative exudatum was collected from patients on the 1st, 2nd, 3rd, and 4th days postoperatively, and osteogenic factor, including alkaline phosphatase (ALP), osteocalcin (BGP), and procollagen type I N-terminal propeptide (PINP), and inflammatory cytokines were performed. Additionally, regular cone beam computed tomography (CBCT) scans were conducted before and after surgery. ResultsOn postoperative days 1–4, the expression levels of ALP, BGP, and PINP were higher in the test group, while those of IL-1α, IL-1β, IL-6, IL-8, and TNF-α, which were identified as co-differentially expressing inflammatory cytokines, were all down-regulated in the exudatum of the test group. Regular CBCT radiological scans revealed a significant osteogenic effect in the test group. ConclusionThe use of CGF combined with iliac cancellous bone and composite bone materials to repair extensive mandibular jaw defects facilitates bone formation and reductions in inflammation in the defect area in the short term, which deserves further research in clinical practice.

Aggressive giant cell tumour of the talus: a rare case report and challenges faced during its management

&lt;p&gt;Giant cell tumour (GCT) of the bone is a locally aggressive benign tumour that commonly occurs in the epiphyseal ends of long bones. Its occurrence in the small bones of the foot like the talus is rare. In this case report we described a case of aggressive GCT of the talus (Campanacci grade 3) in a twenty-one years old male diagnosed by the presence of a well-defined osteolytic lesion seen involving the talar body with cortical breach and soft tissue extension confirmed to be a GCT by closed needle biopsy. The patient was managed surgically by excision of the tumour mass in-toto along with the talus followed by tibio-calcaneal fusion using free fibular strut graft and Ilizarov frame. At 3 months follow up no evidence of fusion was seen and therefore secondary augmentation with a cortico-cancellous graft from the iliac crest was done to aid fusion and Ilizarov fixator was removed 6 months after the surgery. The patient at one year follow up had shown no signs of recurrence of the tumour and has a pain free, stable fused tibiocalcaneal joint with a bipedal unassisted gait. Our case report found excision of talus combined with tibio-calcaneal fusion using free fibular strut graft along with cortico cancellous iliac bone graft to have a good outcome in terms of aiding tibio-calcaneal arthrodesis and thereby providing pain relief and providing a stable foot to the patient.&lt;/p&gt;

Construction of a Pig Alveolar Cleft Model in Imitation of Cleft Lip and Palate Congenital Deformity.

Alveolar cleft repair is a key step in multiple disciplinary treatment for patients with cleft lip/and palate. Although autologous bone grafting has been used worldwide over the past half century, alternative advanced techniques, such as the use of bone substitutes and guided tissue regeneration, have shown their great potentials and have been recommended by a growing number of physicians and surgeons. The employment of new therapeutic approaches and devices in clinical routine requires tremendous experimental efforts and appropriate animal models with similar sizes and sites of deformity to that of human both anatomically and physiologically. The aim of this study is to develop a juvenile porcine model with surgically created alveolar clefts imitating congenital alveolar cleft in the cleft lip and palate. Alveolar defects between second incisor and canine were surgically created in two miniature pigs (unilateral cleft in P1 and P2); bilateral alveolar defects were surgically created between first and third incisor in one miniature pig (P3) using piezo surgery. Pigs were sacrificed (P1 at 1 month after the surgery and P2 at 3 months postoperatively) and the evaluation of defects were performed by assessing result from the computed tomography (CT) scan and histopathological examination. Postoperative CT scan results showed that the size of the defect remained the same, whereas the edge of the defect became irregular 3 months after the surgery. In all pig subjects, histopathological examination found no sign of osteogenesis in the area of defect, indicating that our surgical procedure was successful in establishing porcine models for alveolar cleft in congenital cleft lip and palate. In conclusion, we developed alveolar cleft in porcine models to mimic the size, site, and environment of congenital alveolar cleft in cleft lip and palate. The novel animal model can be employed in pilot studies for the purpose of optimizing the current surgical treatment techniques as well as developing new treatment procedures and test the bone substitute materials. The bilateral model can be applied in further control studies.Impact statementCancellous iliac bone graft was the most popular surgical technique as well as the gold standard to reconstruct alveolar cleft. Nevertheless, several disadvantages exist regarding the additional surgical field of donor side and delayed age of alveolar bone grafting. Bone tissue-engineered strategy offers a promising alternative to address the gap in the current limitation of autologous bone to treat the growing craniofacial skeleton. Among different species of laboratory animals, porcine is suitable for oral and maxillofacial bone and implant-related research, where alveolar defect can be surgically developed simulating the size and site of alveolar cleft occurring together with cleft lip and palate. In this proposal, a reproducible porcine model of alveolar bone defect imitating congenital alveolar cleft during craniofacial growing stage is successfully constructed that will show great potential application in the field of tissue engineering and regenerative medicine. The model for bilateral alveolar cleft can be potentially applied in a controlled study in future.

Post-traumatic forearm bone defect reconstruction using the induced membrane technique

IntroductionThe induced membrane technique, first described by Masquelet, is now well standardized, but little studied in post-traumatic forearm bone defect. The main aim of the present study was to analyze consolidation rates in this indication. The study hypothesis was that the induced membrane technique provides good consolidation results. MethodsWe performed a retrospective assessment of our experience with 10 cases of induced membrane forearm reconstruction. The two main etiologies were acute trauma or treatment for non-union. Functional impact was assessed on range of motion and QuickDASH. The complications rate was also examined. ResultsThere were 3 cases of post-traumatic bone defect, and 7 of non-union treatment, including 6 septic non-unions. Mean defect size was 4.3cm. Mean interval between induced membrane stages 1 and 2 was 3.3 months. Pure cancellous iliac bone graft was systematic. Nine of the patients showed consolidation, at a mean 9.2 months; there was 1 case of non-consolidation, but no other complications. Range of motion was satisfactory; mean QuickDASH score was 22 at a mean 50.3 months’ follow-up. ConclusionThe induced membrane technique was reliable, reproducible and technically accessible, with good functional and radiographic results and few complications. Level of evidenceIV; retrospective study without control group.

Anterior C2-3 fusion surgery alone for highly displaced Hangman’s fracture with severe angulation of C2-3 of more than 30°

BackgroundHighly displaced Hangman’s fracture is a very rare and extremely unstable fracture of the C2 axis. Combined anteroposterior or posterior long-segment fusion surgery is typically performed for the treatment of highly displaced Hangman’s fracture. However, these kinds of surgeries increase the risk of complications, loss of motion, and hospital costs. ObjectiveWe sought to investigate the surgical outcomes of anterior C2-3 fusion surgery alone for highly displaced Hangman’s fractures with severe angulation of C2-3 by more than 30° and discoligamentous injury. MethodsA total of five patients (four men and one woman) were included in this study with a mean age of 40.4 years (range, 26–70 years). The mean follow-up period after surgery was 37.2 months (range, 12–96 months). The fracture characteristics, treatment methods, and outcomes were retrospectively analyzed. ResultsAll five patients had type II Hangman’s fractures (according to the Levine and Edwards classification scheme). None of the included patients had neurologic deficit or other spine injury but all patients had complete C2-3 discoligamentous injury. Before surgery, all patients successfully achieved closed reduction by skull traction, followed by C2-3 anterior decompression and fusion (ACDF) with plating. For interbody grafting, three patients received a polyetheretherketone (PEEK) cage filled with an autogenous cancellous iliac bone graft and two received autogenous tricortical iliac bone grafts. Severe angulation (39.2° vs. 3.0°, P < 0.001) and severe displacement (76.1% vs. 4.0%, P < 0.001) of C2-3 were both significantly corrected after surgery. All patients had achieved solid fusion at last follow-up. In terms of clinical outcomes, the mean neck pain visual analog scale score was significantly improved (8.6 points vs. 1.8 points, P < 0.001). The mean neck disability index value was also significantly improved (45.4 points vs. 13.0 points, P < 0.01). According to Odom’s criteria, all patients achieved satisfactory outcomes. No major complications occurred. One patient complained of dysphagia, but recovered after three months with conservative treatment. ConclusionsPreoperative closed reduction and anterior C2-3 fusion surgery alone should be considered as a less-invasive and useful surgical option for highly displaced Hangman’s fracture with severe angulation of C2-3, which is an extremely unstable fracture of the C2 axis.

Cleft Alveolar Bone Graft Materials: Literature Review.

Since the early stages of alveolar bone grafting development, multiple types of materials have been used. Iliac cancellous bone graft (ICBG) remains the gold standard. A review of literature is conducted in order to describe the different bone filling possibilities, autologous or not, and to assess their effectiveness compared to ICBG. This review focused on studies reporting volumetric assessment of the alveolar cleft graft result (by computed tomography scan or cone beam computed tomography). Grafting materials fall into 3 types: autologous bone grafts, ICBG supplementary material, and bone substitutes. Among autologous materials, no study showed the superiority of any other bone origin over iliac cancellous bone. Yet ICBG gives inconsistent results and presents donor site morbidity. Concerning supplementary material, only 3 studies could show a benefit of adding platelet-rich fibrin (1 study) or platelet-rich plasma (2 studies) to ICBG, which remains controversial in most studies. There is a lack of 3-dimensional (3D) assessment in most articles concerning the use of scaffolds. Only one study showed graft improvement when adding acellular dermal matrix to ICBG. Looking at bone substitutes highlights failures among bioceramics alone, side-effects with bone morphogenetic protein-2 composite materials, and difficulties in cell therapy setup. Studies assessing cell therapy-based substitutes show comparable efficacy with ICBG but remain too few. This review highlights the lack of 3D assessments in the alveolar bone graft materials field. Nothing dethroned ICBG from its position as the gold standard treatment at this time.

Clinical and radiological evaluation of nonvascularized cancellous iliac bone graft for the treatment of nonunited scaphoid fracture

Purpose We evaluated the clinical and radiological outcome of pure cancellous iliac bone graft for the treatment of scaphoid nonunion. Patients and methods The subjects of this study were 30 patients who had a nonunited scaphoid fracture treated with pure cancellous iliac bone graft and casting between March 2015 and April 2019. The average follow-up period was 9 months. We performed open reduction through the volar approach with impaction of the fracture site with pure nonvascularized cancellous iliac bone graft and scaphoid cast for a period ranging from 1 1/2 to 3 months. Results Bony union was achieved in 29 of 30 patients. Nonunion occurred in only one patient.

Treatment of unstable scaphoid waist nonunion with cancellous bone grafts and cannulated screw or Kirschner wire fixation

We compared two methods of fixation for unstable scaphoid waist nonunions regarding rate of scaphoid union, union time, deformity correction, clinical outcomes (pain, range of motion, and grip strength), and QuickDASH scores. Eighty-nine patients who undergo cancellous iliac bone grafting and internal fixation either with a Herbert screw (n = 46) or multiple Kirschner wires (n = 43) were evaluated. The rate of scaphoid union in the K-wire group was 98% (n = 42) versus 89% (n = 41) in the screw group. The mean union time and duration of surgery for K-wire group versus screw group were 12 versus 15 weeks and 45 versus 66 min respectively. There was no significant difference between the two groups with respect to deformity correction, clinical outcomes, and QuickDASH scores. Despite there was no significant difference in the rate of scaphoid union between the two fixation methods, the K-wires procedure had the advantages of short union time, less demanding, and less expensive than the screw implant.

Inevitable nonunion after ulnar shortening osteotomy in patients with ulnar impaction syndrome and breast cancer under bisphosphonate treatment.

Nonunion after ulnar shortening osteotomy (USO) was observed at a high rate in patients undergoing long-term bisphosphonate (BP) maintenance treatment after breast cancer surgery. Here, we report the unique features of these nonunions. In total, 485 patients who had undergone USO between March 2008 and September 2017 were screened for inclusion based on the following criteria: (1) definitive nonunion after USO; (2) prior history of or ongoing BP therapy after the diagnosis of breast cancer; and (3) no evidence of metastasis in the ulna treated with USO, as determined based on the radiological evaluation. Five patients with histories of breast cancer and subsequent BP treatment were identified; all (100%) of these patients showed definitive nonunion after USO. The mean age was 56.2years, and all ulnae were on the contralateral side to that of the original breast cancer. Intravenous Ibandronate® and Zolendronate® were administrated to one and four patients, respectively. The mean period of administration was 67.8months. Three patients exhibited suspicious lesions impending atypical fracture on their femurs, and the other two patients were treated by intramedullary nailing after the occurrence of atypical fractures. Radiological evaluation revealed no evidence of a metastatic lesion, including in the musculoskeletal system, in any patient. Osteosynthesis was performed with cancellous iliac bone graft and mean of 4.3months after osteosynthesis, union in all cases was achieved. Problems associated with BP treatment are well known. Even in cases in which the agent is essential for preventing bony metastasis of breast cancer, the normal bony physiology, including bone turnover and healing, is likely to be compromised. In addition to atypical fractures of the femur and ulna, procedures such as USO are likely to be affected by BP. Furthermore, not only a primary iliac bone graft but also other method (oblique osteotomy) should be needed to avoid nonunion during plating in USO. IV, Retrospective case series.

Speech outcome after intravelar veloplasty

ObjectiveCleft lip and palate is the main craniofacial malformation in France. Many surgical techniques had been described to restore cleft palate. In this study, we evaluate phonation in a homogeneous series of patient with isolated unilateral non-syndromic cleft lip and palate before (and after) alveolar cleft closure, operated according to our surgical protocol. MethodsWe included retrospectively 71 patients with isolated non-syndromic unilateral cleft lip and palate (UCLP), operated in our department from 2009 to 2013. All patients underwent the same surgical protocol: modified Millard cheilorhinoplasty (from 5 to 9-month-old); direct hard palatal closure (from 12 to 20-month-old); alveolar cleft closure with cancellous iliac bone graft (from 4 to 6-year-old). The phonation and clinical statute were evaluated before and after alveolar cleft closure. Fistula rate and speech evaluation were recorded. ResultsThe rate of oronasal fistula was 12.7%. About phonation, 76% and 86% of patients were competent or borderline competent respectively before and after gingivoperiostoplasty. ConclusionThis surgical protocol provided speech results in patients with isolated unilateral non-syndromic cleft lip and palate. The gingivoperiostoplasty improved the speech intelligibility.

Assessment of Bone Formation After Secondary Alveolar Bone Grafting With and Without Platelet-Rich Plasma Using Computer-Aided Engineering Techniques.

The aim of this study was to analyze the newly formed bone volume (FV), 6 months after secondary alveoloplasty using iliac cancellous bone graft, with and without platelet-rich plasma (PRP). Forty patients with unilateral alveolar cleft were involved in this randomized, prospective, comparative study, with 20 patients each forming the control (group A) and PRP (group B) groups, respectively. The preoperative alveolar defect volume (DV) and the postoperative FV were automatically calculated by the computer-aided engineering software using the patients' pre and postsurgical computed tomography data. The volume of the actual bone graft (AV) was identical to the DV calculated before surgery. The bone formation ratio (BF%) was calculated as follows: BF% = (FV/AV) × 100%. The mean BF% was 42.54 ± 9.32% in group A and 46.97 ± 18.49% in group B. There was no statistically significant difference between the 2 groups for BF% (P > 0.05). The study presents a fast and accurate method for assessing the effect of PRP in alveolar grafting. However, the study found no conclusive evidence on the effect of PRP on bone growth.

Assessment of Bioabsorbable Hydroxyapatite for Secondary Bone Grafting in Unilateral Alveolar Clefts.

To evaluate the utility and efficacy of bioabsorbable hydroxyapatite and collagen complex (HA/Col) for secondary bone grafting in unilateral alveolar clefts. Between 2015 and 2016, 21 patients with unilateral cleft lips and alveolar clefts were enrolled. In group I, a cancellous iliac bone graft was placed at the alveolar cleft (6 males, 5 females). In group II, a bioabsorbable HA/Col was placed at the alveolar cleft (4 males, 7 females). The groups did not differ in age, cleft volume, or surgical duration. There was a significant difference in intraoperative blood loss between the 2 groups (6.7 ± 1.89 mL in group II vs 38.8 ± 9.73 mL in group I [P < .01]). The use of patient-controlled intravenous analgesia was also significantly lower in group II than in group I (2.2 ± 1.9 times vs 12.2 ± 4.4 times [P < .01]). Only 1 female in group II who had maxillary sinusitis did not achieve osteosynthesis. With the exception of this patient, the 12-month bone volumes in groups I and II were 0.567 ± 0.066 and 0.596 ± 0.073 mL, respectively, without significant difference (P = .18). Compared with an autogenous bone, bioabsorbable HA/Col significantly reduces postoperative pain. In addition, the use of HA/Col alone produced the same result as an autologous bone and is effective in filling the alveolar cleft.

Comparative Outcomes of Block and Cancellous Iliac Bone Grafting in Older Unilateral Alveolar Cleft Patients.

To compare osseous outcomes of block and cancellous iliac bone grafting in older unilateral alveolar cleft patients. Retrospective and observational follow-up study. Cleft Lip and Palate Centre, Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, China. Forty-five nonsyndromic patients with unilateral complete alveolar cleft were enrolled in this study (25 patients in block bone graft group and 20 patients in cancellous bone graft group). In cancellous bone graft group, the alveolar cleft was filled with iliac cancellous bone particulate. In group of block bone graft, the harvested bone block was trimmed and fixed in alveolar defect. A novel method was proposed to investigate the volume and density of residual bone graft at 1-week, 3- and 6-month, 1- and 2-year postoperatively based on cone beam computed tomography scans. No difference in bone graft volume was found between 2 groups at 1-week and 3-month postoperatively; however, the residual volume of block bone graft group was significantly larger than that of cancellous bone graft group at 6-month, 1- and 2-year postoperatively. The bone density of block bone graft group was lower at 1-week and 3-month postoperatively but was comparable at 6-month, 1- and 2-year postoperatively. Our method was reliable and accurate to identify the range of residual bone graft when the boundary of grafted bone could not be identified clearly. Block bone graft could achieve comparable bone density and retain a greater amount of residual bone comparing to cancellous bone graft.