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      Management of Alveolar Cleft

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          Abstract

          The alveolar cleft has not received as much attention as labial or palatal clefts, and the management of this cleft remains controversial. The management of alveolar cleft is varied, according to the timing of operation, surgical approach, and the choice of graft material. Gingivoperiosteoplasty does not yet have a clear concensus among surgeons. Primary bone graft is associated with maxillary retrusion, and because of this, secondary bone graft is the most widely adopted. However, a number of surgeons employ presurgical palatal appliance prior to primary alveolar bone graft and have found ways to minimize flap dissection, which is reported to decrease the rate of facial growth attenuation and crossbite. In this article, the authors wish to review the literature regarding various advantages and disadvantages of these approaches.

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          Presurgical nasoalveolar molding in infants with cleft lip and palate.

          B Grayson, Araceli Santiago, C Cutting … (1999)
          Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. In this paper, we present a paradigm shift from the traditional methods of presurgical infant orthopedics. Some of the problems that the traditional approach failed to address include the deformity of the nasal cartilages in unilateral as well as bilateral clefts of the lip and palate and the deficiency of columella tissue in infants with bilateral clefts. The nasoalveolar molding (NAM) technique we describe uses acrylic nasal stents attached to the vestibular shield of an oral molding plate to mold the nasal alar cartilages into normal form and position during the neonatal period. This technique takes advantage of the malleability of immature cartilage and its ability to maintain a permanent correction of its form. In addition, we demonstrate the ability to nonsurgically construct the columella through the application of tissue expansion principles. This construction is performed by gradual elongation of the nasal stents and the application of tissue-expanding elastic forces that are applied to the prolabium. Use of the NAM technique has eliminated surgical columella reconstruction and the resultant scar tissue from the standard of care in this cleft palate center.
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            Treatment variables affecting facial growth in complete unilateral cleft lip and palate.

            R. Paul Ross (1986)
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              Management of alveolar clefts.

              Sunil Bajaj, A Punjabi, Amnart Wongworawat (2003)
              The management of alveolar clefts has changed through the years as medical knowledge has improved. An alveolar cleft is the result of abnormal primary palate formation during weeks 4 to 12 of gestation. The rationale for its closure includes 1) stabilizing the maxillary arch, 2) permitting support for tooth eruption, 3) eliminating oronasal fistulae, and 4) providing improved esthetic results. Methods for closure of the alveolar cleft have been solidified during the last century with the use of bone grafting. Secondary bone grafting is now the preferred method of treatment, because early grafting has proven detrimental to midfacial growth. Various materials for bone grafting have been proposed, including iliac crest, cranium, tibia, rib, and mandibular symphysis. Regardless of the timing and materials used, the main principles in approaching alveolar clefts have been well described. They include 1) appropriate flap design, 2) wide exposure, 3) nasal floor reconstruction, 4) closure of oronasal fistula, 5) packing bony defect with cancellous bone, and 6) coverage of bone graft with gingival mucoperiosteal flaps. Certain alveolar clefts are difficult to manage by grafting alone, and orthodontic preparation may be required. Complications of alveolar bone grafts include donor site morbidity as well as graft exposure and loss.
              Article 0 comments Cited 36 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Craniofac Surg
                Journal ID (iso-abbrev): Arch Craniofac Surg
                Journal ID (publisher-id): ACFS
                Title: Archives of Craniofacial Surgery
                Publisher: The Korean Cleft Palate-Craniofacial Association
                ISSN (Print): 2287-1152
                ISSN (Electronic): 2287-5603
                Publication date (Print): August 2015
                Publication date (Electronic): 11 August 2015
                Volume: 16
                Issue: 2
                Pages: 49-52
                Affiliations
                Department of Plastic and Reconstructive Surgery, Chungnam National University School of Medicine, Daejeon, Korea.
                Author notes
                Correspondence: Nakheon Kang. Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. nhk488@ 123456cnu.ac.kr
                Article
                DOI: 10.7181/acfs.2015.16.2.49
                PMC ID: 5556848
                PubMed ID: 28913221
                SO-VID: 700ea0e9-4310-4bb7-a8b4-209ea171309f
                Copyright © © 2015 The Korean Cleft Palate-Craniofacial Association
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 05 August 2015
                Date revision received : 06 August 2015
                Date accepted : 06 August 2015
                Categories
                Subject: Review Article

                Keywords: cleft lip,cleft palate,alveolar bone grafting,periosteum
                Data availability:
                Keywords: cleft lip, cleft palate, alveolar bone grafting, periosteum

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