Cleft Lip & Palate - Alveolar Bone Graft
Alveolar Bone Graft
A cleft that extends into the bone of the upper jaw is referred to as an alveolar cleft. Typically the cleft extends into the gingiva and bone of the area with a direct communication into the nose. This area requires repair for several reasons:
To allow proper eruption of the permanent canine tooth in the area
To allow for a superior functional and aesthetic dental result
To eliminate the connection between the mouth and nose in the area
To help provide support of the upper lip and nostril in the affected area
To stabilize the upper jaw, especially in bilateral cases
The timing of the repair is based on the canine tooth in the area. Ideally the cleft is repaired with a bone graft around the time the canine tooth erupts. This allows the canine tooth to erupt into the repaired cleft, stimulating and remodeling the bone graft.
Correction of the alveolar cleft requires correction of the soft tissues as well as the bone in the area. Correction of the bony cleft typically requires a bone graft. Bone grafting involves taking a small amount of bone, usually from the hip, and placing it in the area of the cleft.
Members of our team developed a surgical technique for obtaining a bone graft from the hip that has been used as a teaching guide in multiple surgical training programs. The technique was developed by members of our team and published in 1980. It has been used on a regular basis in our center since that time. Our technique uses a lateral approach instead of a medial approach to the hip site, resulting in less disruption of soft tissues in the area. The procedure is very well tolerated, and our patients are up and walking the next day.
In certain circumstances, the cleft segments can be repositioned to eliminate the bony cleft, avoiding the need for a bone graft. When this is an option, it may need to be done at the time of corrective jaw surgery.
Mrazik J, Amato C. The ilium as a source of autogenous bone for grafting: clinical considerations. J Oral Surg. 1980 Jan;38(1):29-32.