Varying Concepts in Bone Grafting of Alveolar Palatal Defects

Abstract

The increasing interest in and apparent success of techniques used by many of our European colleages for using an autogenous bone graft for bridging the gap of clefts in the alveolar ridge with the resultant stabiliza— tion of the alveolar ridge and associated surrounding palatal bone stimulated us to adapt some of these procedures, both as primary and secondary osteoplasties. Approximately 10 years ago interest in closure of secondary alveolar clefts (including the palate) was reported by Nordin and J chan-son (3) of Sweden and at about the same time by Schmidt (4) of Germany. Schrudde and Stellmach (5, 6) in 1958 reported on their experiences in the use of autogenous rib grafts in bridging defects anterior to the alveolar process. A concerted effort was made by these and other surgeons to utilize various types of flaps and sources of autogenous bone for reconstruction of both the alveolar arch and, as much as feasible, the bony palate in order ' to have the maxilla retain its proper relationship with the mandible during facial growth. (541). In initiating a review of over 2,200 of our cleft lip and palate patients, it became clear to us that many of our results, particularly in the bilateral cleft and complete alveolar cleft group, were short of our desired goals from both functional as well as esthetic standpoints. In order to better understand the surgical possibilities for a more satisfactory attainment of our goals, we endeavored to review the various European schools of thought and we visited some of the maxillofacial centers of interest to discuss with them and see first hand their approach to the problem. The various clinics and clinicians we visited, over a two year period, were kind enough to show us many of their post-operative results both in primary and secondary cleft lip and palate patients. We discussed operative procedures, per se, and were able to examine the exceedingly fine collections of pre— and post-operative radiographs, study models, and appliances which were obtained pre—operatively as well as post—operatively following bone grafting of the alveolar cleft.