Clinical Study Of Cancellous Iliac Bone Grafting In Cleft Alveolar Repair

cleft Lip and palate is one of the most common congenital deformities, with its incidence of 1.82%. It has long been an issue discussed by clinicians how to treat such patients to a satisfactory extent. With further study of physiology and pathology of the patients with cleft lip and palate and biological activity of dissociative bone grafts, like cleft lip and palate repair, bone grafting in cleft alveolar repair, has become an important operative process in comprehensive and systematic treatment of cleft lip and palate. Whereas there exist various opinions on operative applications, timetables, methods and choices of donor sites. Adopting autologous cancellous iliac bone grafts in cleft alveolar repair of patients with cleft lip and palate, evaluation of maxillary continuity, alveolar height, the shape of nasal floor and eruption of canines in patients of different ages were performed through post-operative interviews.Objective: this study evaluates the transformation of implanted grafts after the cancellous iliac bone grafting in cleft alveolar repair of cleft lip and palate patients of various ages, and eruption of canines in cleft sites.Methodology: 36 patients with residual cleft alveolar after cleft lip and palate operation were divided into two groups according to their canine eruption: group A was consisted of patients with non-erupting canines, andgroup B erupting. All of the patients were treated with cancellous iliac bone grafting in repair, and in one month, two months, half a year and one year after operation respectively, healing of wounds, maxillary continuity, alveolar height in graft sites and the shape of nasal floor were observed through clinical interviews and radiographs. In group A, eruption of canines and erupting sites were observed with emphasis.Results: The cancellous wounds in 36 patients completely healed, and after half a year, no complications occurred. Intraoral wounds dehiscence and the bone tissues loss occurred in one patent; In three patients in group A and two in group B, partial wounds dehiscence occurred within 1-2 weeks after operation with a bit of bone tissues exposed, and after the removal of the sequestra on the surface, the wounds healed well; in the rest of the patients, the wounds completely healed. In the 36 cases, all the maxillary continuity was restored except one. After a year of reconstruction by implanted grafts, alveolar height and the nasal floor were all lowered. In group A, the canines to be erupting all moved to the graft sites. The canines of 69% patients erupted within one year postoperatively. The alveolar height increased with the eruption of canines.Conclusions: cancellous iliac bone is a favourable donor for cleft alveolar repair with its large quantity of bones to be donated and few local complications; after bone grafting in cleft alveolar, alveolar continuity can be restored, fistulas in oral and nasal cavities can be closed and the height ofnasal floor and alveolar in affected sides can also be improved; bone grafting before eruption of canines is more effective than after eruption, because after bone grafting, eruption of canines can take place in normal sites, and simultaneously, normal alveolar can be formed; since cleft alveolar bone grafting is more difficult, and especially in the operation, nasal floors, oral vestibules and mucous membrane and periosteum valves in palates should be completely closed, the pivotal points are sufficient loosing of periosteum valves and non-strain suture. Since the nasal floor is lowered after one year of reconstruction by implanted grafts, the secondary deformities of nose and lips are best reconstructed after cleft alveolar bone grafting.