Early Bone Grafting with the Functional Cleft Lip Repair

ABSTRACT

The treatment of complete clefts of the lip and palate is controversial; many protocols and surgical techniques are utilized. In addition, long-term outcome assessments of these many clinical approaches are generally not available. In contrast, the protocol presented here, which includes presurgical orthopedics in the form of a passive palatal plate, functional cleft lip repair, and primary (early) autogenous bone grafting, has been followed without modification since its inception in 1965. Numerous long-term studies that include examination of graft survival, effect on facial growth, integrity of the dentition adjacent to the cleft, and subsequent need for orthognathic surgery are discussed. This protocol results in a successful outcome for the child with a complete cleft of the lip and palate. The appliance fabrication, cleft lip repair, and bone graft placement are uncomplicated and technically easy to learn. Most important, the results (i.e., maxillary growth, esthetic and functional results of lip repair, and occlusion) are impressive in spite of a protocol that is straightforward and can be followed incorporating any type of lip repair with muscle realignment and any palate closure that results in an early complete closure.

KEYWORDS

Functional lip repair - palatal prosthesis - early alveolar bone graft

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