Abstract
Similar to the child with unilateral cleft lip and palate, in order to obtain a successful result for the repair of a bilateral maxillary alveolar cleft, one needs to consider all aspects of the patient before plunging into surgery. One must not lose sight of the primary goal of surgery, which is to foster a healthy, happy child that grows into adulthood without the stigmata of their birth defect — a person who has strong self-esteem, has positive self-worth, and can integrate well with their family, friends, and society. A successful alveolar bone graft is more than simply “closing a hole”, or “allowing the canine to erupt”. In this regard, there is no greater challenge than a child born with bilateral cleft lip and palate (BCLP). They have likely endured multiple previous interventions and many social interactions that have shaped their personality. At this time a holistic analysis of the patient should be accomplished. A thorough speech, feeding, audiological, dental, orthodontic, and psychological review is a necessary part of the work-up for a patient undergoing alveolar cleft bone grafting. All options, including no treatment, should be considered along with the burden of care to the family. Only at this point can we say the patient is ready for surgery.
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Change history
12 October 2023
A correction has been published.
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7.1 Electronic Supplementary Material
Using gutta percha to determine the extent of a palatal fistula. The first three passes by the surgeon demonstrate fistulae, so the gutta percha remained straight. The fourth pass was a crevice, so the fine end of the gutta percha curled back (MP4 33496 kb)
Releasing the periosteum to allow for buccal sliding flap to medialize and close wound without tension (MP4 94510 kb)
Excising the fistula while leaving adequate nasal mucosa for primary repair (MP4 69076 kb)
The nasal mucosa has been repaired and is now pushed back into the nasal cavity recreating the entire bony defect (MP4 48340 kb)
Intraoral view through the nasolabial fistula demonstrates an enlarged inferior turbinate. As the camera moves to the nostril, again the engorged obstructing turbinate is easily seen (MOV 91539 kb)
Amateur intraoperative video of left unilateral maxillary bone grafting (MP4 2379626 kb)
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Ricalde, P. (2023). Surgical Repair of Maxillary Bilateral Cleft Defect. In: Ricalde, P. (eds) Cleft Maxillary Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-031-24636-4_7
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DOI: https://doi.org/10.1007/978-3-031-24636-4_7
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