Morphologic Changes Of Soft Tissue After Alveolar Cleft Repair With Buccal Mucosal Flap Closure

Objective: The purpose of this study was to investigate the morphologic changes of soft tissue after alveolar cleft repair with buccal mucosal flap closure and compare the differences and similarities of transplanted buccal mucosa (TBM) with normal buccal mucosa (NBM) and normal attached gingival mucosa (NGM) respectively, and to explore whether TBM can form normal periodontal structures postoperatively or not and its morphological features.Methods: 10 samples of 9 patients who had undergone alveolar cleft (AC) repair with buccal mucosal flap closure in the Department of Stomatology, Xiangya Hospital of Central South University, and 10 controls of normal buccal and gingival mucosa each were recruited. Probing depth of the canine gingival sulcus in the cleft side was measured and compared with normal controls. An anterior maxillary occlusal X-ray film of each patient was taken and the alveolar height of the cleft was recorded. Labial attached gingival mucosa of maxillary canine (TBM and NGM group) and buccal mucosa opposite to the 1st premolar (NBM group) were harvested, then formalin-fixed and paraffin-embedded (FFPE). Paraffin-embedded tissue samples were sectioned and hematoxylin-eosin stained, and light microscope (LM) was utilized to determine histomorphologic changes.Results: (1)Soft tissue overview differences existed between patients after AC repair and normal controls. (2)The depth of canine gingival sulcus was of no significant differences between subjects who had undergone alveolar cleft repair with buccal mucosal flap closure and normal controls. (3)All patients recruited in the experiment demonstrated successful bone grafting results so odds caused by this matter can be excluded. (4)There was a cuticular layer in the epithelium of the transplanted flap buccal mucosa like normal gingival mucosa, when compared with normal buccal mucosa. The rete pegs in the epithelium of TBM were longer than normal buccal mucosa, and larger in quantity. But they were shorter in length, less regular in arrangement and smaller in quantity when compared with normal gingival mucosa. Conclusion: (1) Buccal mucosal flap is a proper source for soft tissue coverage in wide cleft alveolus bone grafting. (2) The transplanted buccal mucosal flap can gradually develop into a structure similar to normal gingiva postoperatively as time lasts. (3) Canines can erupt in the impaired side after alveolar bone grafting with buccal mucosal flap closure and possess approximately normal gingival sulci and periodontal structures.