| Background Cleft lip is a common congenital disease, one common concomitant symptom of which is alveolar clef. Autogenous iliac is the best material for alveolar clef bone graft because of its no immune rejection and high rate of ossification, at the same time it also has its own shortcomings, the complication of getting ilium such as incision infection and postoperative incision scar hyperplasia and bone graft osteogenesis rate are inevitable problems; In order to avoid the shortcomings of autogenous iliac grafts, Studying on alveolar cleft grafting materials is always an important subject. Autogenous bone, allograft bone, xenogenic bone and biological material have been successfully used in clinic, and achieved good results. Different materials have different advantages and disadvantages; the body reaction of different materials is related with material spices, properties, surface structure, morphology, implantation and functional status and so on.Objective We observe the feasibility and reliability of repairing alveolar cleft bone defect by costal cartilage, allograft bone, xenogenic bone and Medpor, to explore idealalveolar cleft bone grafting material.Methods 60 cases of patients aged 12-23 years with congenital unilateral alveolar cleft, were randomly divided into A, B, C, D four groups, 15 cases in each group, the patients of D group aged 18-23 years. Four groups were respectively repaired by costal cartilage, allograft bone, xenograft bone and Medpor. Each group was contrasted by others. One week after surgery, we observed that the soft tissue of all patients in four groups healed. At preoperative, 1 month and six months after surgery, we observed the reconstruction of alveolar cleft by using the method of three dimensional CT reconstruction and X-ray, to compare the effect of four kinds of material in repairing the alveolar cleft bone defect.Results One week after surgery, the wound of all the patients in group A were repaired by costal cartilage healed well and had no infection and duplication reflection.Six months after the operation, the three dimensional CT reconstruction showed that transplanted rib cartilage survived well and all patients got obvious correction effect,without infection, rejection and duplication reflection. One week after surgery, The one patient of group B were repaired by allograft bone occurred graft leakage,after dressing a wound again, the wound healed well. There were no infection,rejection and duplication reflection in the rest of patients. Six months after the operation, the three dimensional CT reconstruction showed there was no obvious difference between grafting and adjacent bone. All patients got obvious correction effect, without infection, rejection and duplication reflection. One week after surgery, the wound of all the patients in group C were repaired by xenograft bone healed well and had no obvious infection, rejection and duplication reflection. Six months after the operation, the three dimensional CT reconstruction showed there was no obvious difference between grafting and adjacent bone. All patients got obvious correction effect, without infection, rejectionand duplication reflection. One week after surgery, The one of patients in group D were repaired by Medpor occurred graft leakage, but after taking out the grafting, the wound healed well. There were no infection, rejection and duplication reflection in the rest of patients. Six months after the operation, the three dimensional CT reconstruction showed that Medpor material was fixed intact in the defect. All patients got obvious correction effect, without infection, rejection and duplication reflection. According to the alveolar morphology, which we got by nasal base CT scan and three dimensional reconstruction in preoperative and postoperative and statistical analysis, we can determine the clinical effect of the four materials have no obvious difference in repairing of alveolar cleft bone defect.Conclusions 1. Autogenous costal cartilage as implant material,without immune rejection and insufficiency of implant materials, can get a fixed appearance after the operation, but it only can play a supporting role, without osteogenesis function. The patient under 12 cannot use this material, which will affect the eruption of the canine teeth, and it will increase the incision and the postoperative complications to take out the costal cartilage, which is the secondary injury for patients; but for old patients, this material has positive effect for its low absorption rate. 2. Allogeneic bone as implant material can avoid the harm of patients for removing the autogenous bone, can get high success rate, and has good histocompatibility, but after the operation alveolar ridge height formed by graft bone may do not meet the operation requirements, so we may require secondary surgery. This material can be substituted by autologous bone. 3. The heterogeneous bone as implant material which can avoid the damage of the patient caused by removing the costal cartilage, has obvious osteogenesis effect and high osteogenesis rate, and has good histocompatibility. More other compound BMP has strong induction osteogenesis ability, so it can play a strong role of inducing osteogenesis in the reconstruction of repairing alveolar burst, but there is ashortage that after the operation alveolar ridge height formed by graft bone may do not meet the operation requirements. 4.The heterogeneous bone as implant material can avert the harm of patients for removing the autogenous bone, and there is no shortage situation of implant materials and no postoperative appearance change problem causing by absorption degradation, so postoperative appearance effect is good; after operation if patients want to remove the graft, it don’t damage the maxilla and the surrounding tissue, and its histocompatibility is good; due to its poor mechanical strength, it may occur broken due to external force such as severe bump, and Medpor only has the support role, no osteogenesis function; for patients under age 18, this material should be used with caution. |
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