A COMPARISON OF ALVEOLAR BONE-GRAFTING WITH AND WITHOUT SIMULTANEOUS MAXILLARY OSTEOTOMIES IN CLEFT-PALATE PATIENTS

Nineteen unilateral and 19 bilateral alveolar clefts (group A) were gr afted with cancellous iliac bone by a standard method, and 21 unilater al and 15 bilateral clefts (group B) underwent simultaneous maxillary osteotomies and alveolar bone grafting with cancellous iliac bone. The two groups were retrospectively evaluated clinically and radiographic ally for alveolar bone level (ABL), attached keratinized gingiva (AKG) , sulcus depth (SD), and persistence of oronasal fistulae (ONF). The f ollow-up ranged from 6 to 54 months with a mean of 23 months for group A and 26 months for group B. In group A, AKG ranged from 1 to 10 mm ( mean 5 mm), most patients having deep or normal SD and type I ABL as m easured according to the Oslo method. No persistent ONF was noted. In group B. AKG ranged from 0 to 8 mm (mean 3 mm), half the patients show ing a shallow sulcus, most with type II or III ABL. In this group, a 4 % failure rate of the bone grafting was noted and 6% fistula persisten ce. It is concluded that the overall results of standard alveolar bone grafting are better in this series than those of simultaneous osteoto my cases, results which are still quite acceptable because they are co mparable with published results of standard alveolar bone grafting. Th e results of this study indicate that simultaneous osteotomy with alve olar bone grafting in cleft patients does not compromise the outcome o f bone grafting; therefore, they support the one-stage surgical manage ment of patients with ungrafted clefts and maxillary hypoplasia.