Tibia as donor site for alveolar bone grafting in patients with cleft lip and palate: Long term experience

Tibial bone grafts were studied in 137 patients with clefts of the lip and palate. Twenty-one had clefts of the lip and primary palate and 116 had com plete unilateral clefts of the lip and palate. Bone grafting was performed secondarily or late secondarily. Bone was harvested from the proximal part of the tibia distal to the tuberosity through an incision about 15 mm long. The mean follow-up time after bone grafting was 5.5 years (range 2-11). Th ere were no operative, or early or late postoperative complications reporte d (such as haematoma, fracture, or shortening of the limb). Harvesting time was about 15 minutes. The possibility of operating with two teams makes th e total operating time shorter. Bleeding was negligible (less than 15 ml) a nd the amount of bone obtained was always sufficient. Patients were mobilis ed the next day and were back to full physical activity by one month. Indic ations for tibial bone grafting included facilitation of tooth eruption int o the graft, giving bony support to the neighbouring teeth, making it possi ble to insert a titanium fixture, raising the alar base of the nose, and cl osing an oronasal fistula. Compared with iliac, cranial, mandibular, and co stal donor sites, using the tibia took less time, gave less bleeding, made it possible for two teams to operate simultaneously, gave a smaller scar, a nd there were minimal complications and satisfactory quantity and quality o f bone in all cases. The results suggested that the tibia is an excellent c hoice of graft for residual alveolar clefts in patients with cleft lip and palate.