BONE-GRAFTING THE PIRIFORM APERTURE DEFORMITY IN ISOLATED CLEFT-LIP PATIENTS - INDICATION, TECHNIQUE, AND RESULTS

Purpose: This study was undertaken to determine the effect of a bone g raft in the piriform aperture on the nasal deformity,and orthodontic t reatment of the cleft side teeth in isolated cleft lip patients. Patie nts and Methods: All primary cleft lip repair was done 3 months after birth. Nine patients, four female and five male, with a mean age of 12 .5 years (range, 8.2 to 24.8 years) and with a repaired cleft lip, wer e bone grafted between 1992 and 1996. The mean postoperative period wa s 2 years (range, 1 to 4 years). An iliac crest bone graft was placed in the piriform aperture deformity on the side of the cleft lip. The i mprovement in the nasal symmetry and angulation of the cleft side teet h were evaluated. The eight growing cleft lip patients (mean age, 11 y ears; range, 9 to 13 years) were compared with a control group of eigh t healthy growing children (mean age, 11 years; range, 9 to 13 years). The improvement of nasal symmetry was measured by the formula of the lobule portion of the columella index preoperatively and postoperative ly. Results: The mean lobule portion of the columella index preoperati vely was 41.8% (SD, 4.4%; SE of Mean, 1.5%) and postoperatively was 44 .2% (SD, 4.9%; SE of Mean, 1.6%) (P >.006, t-test for paired samples). The angulation of the cleft side teeth was improved by orthodontic tr eatment. Conclusion: Bone grafting the piriform aperture deformity res ults in a stable result and improves nasal symmetry and the angulation of the cleft side teeth.