Facial plast Surg 2007; 23: 140-145 DOI: 10.1055/s-2007-979283
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.
Direct Gingivoperiosteoplasty with Palatoplasty
William D. Losquadro1, Sherard A. Tatum2
1 Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University, Syracuse, New York 2 Central New York Cleft and Craniofacial Center, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University, Syracuse, New York

ABSTRACT

Gingivoperiosteoplasty creates a mucoperiosteal bridge across the alveolar cleft associated with cleft lip and palate. The subperiosteal tunnel allows for bone generation in the absence of bone grafting in young patients. The original procedure required wide maxillary subperiosteal dissection and flap rotation but has since evolved along with techniques to narrow the alveolar cleft toward limited dissection and direct closure. Multiple studies reveal superior facial growth parameters, particularly vertical maxillary growth, when compared with primary bone grafting typically performed within the first year of life and a reduced need for later secondary bone grafting. Most centers that perform gingivoperiosteoplasty do so in conjunction with primary lip closure after initial narrowing of the cleft with presurgical orthopedics. We present our method of direct gingivoperiosteoplasty performed simultaneously with palatoplasty after alveolar cleft narrowing without presurgical orthopedics via a two-stage lip repair. Preliminary data suggest bone growth capable of supporting tooth eruption without significant growth disturbances in a majority of patients treated with this protocol.

KEYWORDS

Gingivoperiosteoplasty - periosteoplasty - cleft palate - cleft lip - palatoplasty - alveolar cleft