The Mandibular Ramus: An Alternative Donor Site for Secondary Alveolar Bone Grafting in Clefts of the Alveolus

Blatter, Jeannine; May, Laurence; Roessingh, Anthony de Buys; Medinger, Laurent; Broome, Martin

doi:10.1097/scs.0000000000005684

Cited by 5 publications

(4 citation statements)

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“…For the control group, we have chosen the mandibular ramus as the donor site as it has been described as one with the lowest morbidity 23,31,32…”

Section: Discussionmentioning

confidence: 99%

“…For the control group, we have chosen the mandibular ramus as the donor site as it has been described as one with the lowest morbidity. 23,31,32 In our usual practice, mandibular graft has shown to be particularly reliable first because of the poor scarring (the incision is completely intraoral). In the second instance, the mandible has the same embryonic origin as the maxilla and this might explain the reason for the great bone incorporation (both jaws have a common ectomesenchymal origin and intramembranous ossification.…”

Section: Discussionmentioning

confidence: 99%

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A 3-Dimensional Evaluation of Bone Density in Alveolar Cleft Grafting Methods: Bone Substitutes Versus Autologous Bone

Bianchi

Cicciù

Ruggiero

et al. 2022

Journal of Craniofacial Surgery

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Introduction: Secondary alveolar cleft repair using autologous bone graft is currently the gold standard in treating residual alveolar clefts. Despite its effectiveness, this technique is still burdened by several withdrawals, mostly related to donor site morbidity. To decrease disadvantages for patients, numerous attempts in the literature regarding bone substitutes have been described. The aim of this study is to compare the viability of bovine-based replacement bone material with respect of autologous bone graft in alveolar cleft reconstruction, through 3-dimensional alveolar cleft segmentation and bone density evaluation from preoperative and postoperative cone-beam computed tomography. Patients and Methods: A retrospective cohort study of 10 patients who underwent surgical procedure for alveolar cleft grafting at Sant’Orsola Malpighi University Hospital of Bologna from December 2012 to December 2016 was undertaken. Five patients received autologous bone graft and 5 a bovine bone substitute graft. Preoperative and immediate postoperative orthopanoramic x-rays were recorded. Cone-beam computed tomography scans have recorded both pre and postoperatively. Volumetric evaluation on 3-dimensional cone-beam computed tomography images was performed. Results: Alveolar clefts repaired using substitute bovine bone/biological membrane scaffold had a mean fill of 69.00% of total cleft volume, while this figure was of 67.07% with autologous bone grafting. The immediate postoperative course and subsequent discharge were uneventful for both groups, with a difference in timing. The cost of substitute bovine bone was offset by cost savings associated with a reduction in operative and postoperative and hospitalization time. Conclusions: Bone substitutes showed to be a promising solution in alveolar cleft grafting.

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“…For the control group, we have chosen the mandibular ramus as the donor site as it has been described as one with the lowest morbidity 23,31,32…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A 3-Dimensional Evaluation of Bone Density in Alveolar Cleft Grafting Methods: Bone Substitutes Versus Autologous Bone

Bianchi

Cicciù

Ruggiero

et al. 2022

Journal of Craniofacial Surgery

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“…Cancellous bone for the graft was harvested, usually from the iliac crest or from the mandibular ramus. 22 Orthodontic diagnosis and treatment planning were done around the age of 12, that is, by the end of the mixed dentition period. Orthodontic treatment was often combined with orthognathic surgery.…”

Section: Methodsmentioning

confidence: 99%

Unilateral Cleft lip and Palate: Long-Term Results of the Malek Technique

Roessingh

Robert

Despars

et al. 2022

The Cleft Palate Craniofacial Journal

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To review at 18 years-old the results of surgery and follow-up of children born in our hospital with unilateral cleft lip and palate (uCLP). They were operated at the time by the same surgeon, following the same primary surgical procedure (Malek). Retrospective cohort study. Tertiary Children's Hospital. All children born with uCLP between 1996 and 2001 and operated in our hospital. Syndromic children were excluded. Results of the primary surgery, ear–nose–throat interventions, maxillo-facial surgery and final phonatory results. Seventy-nine files of children born with a cleft were reviewed: 34 were taken into consideration for uCLP: 15 right and 19 left. They were operated in two stages, following the inverse Malek procedure. Sixty per cent had a fistula. Eighty-eight percent had grommets. Ninety-seven percent had an alveolar graft at a median age of nine (5-10) and 22% underwent a Le Fort osteotomy. Seven percent were operated for a pharyngeal flap, 29% for a secondary lip surgery at a mean age of 12.8 and 29% for a late rhinoplasty at a mean age of 14.8 years. A median of 5.7 multidisciplinary consultations was realized with a median number of general anesthesia of 7.1 (4-13). This retrospective study shows that the Malek procedure for children born with uCLP is related to a high risk of fistula but good long-term phonatory results. Twenty percent of children were operated for a Le Fort procedure and one-third for a secondary lip procedure and rhinoplasty.

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“…The orthodontic treatment was correlated with the planning of the alveolar bone graft (ABG) when a maxillary cleft existed, with missing teeth (canines, incisors, and molars) or hypoplastic/improperly placed teeth [29,30]. The spongious bone for the graft was taken from inside a normal bone, usually from the iliac crest, or from the mandibular bone [31]. Around the age of twelve, we considered the relationship between the upper and lower jaws and the malposition of the teeth.…”

Section: Orthodontic and Maxillofacial Surgical Proceduresmentioning

confidence: 99%

What We Learned from Performing the Inverse Malek Procedure to Repair Bilateral Cleft Lips and Palates: A Single-Center Retrospective Study

Al-Dourobi,

Mermod,

Doan

et al. 2024

JCM

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Background: This study reviews the surgical and functional outcomes of children diagnosed with a bilateral cleft lip and palate and treated by the same surgical team following specific surgical protocols 18 years after surgery and during the follow-up. Methods: Based on a single-center retrospective design, demographic and surgical data were gathered by the authors from international institutions. Most of the data were quantitative in nature, and descriptive statistical and non-parametric tests were employed for analysis. All children born with a bilateral cleft from 1982 to 2002 were considered. Children affected by a syndrome were excluded. Complications and speech results were the main items measured. Results: Thirty patients were selected; 73.3% were treated using the inverse Malek procedure, and 26.7% underwent a modified two-stage procedure. Seventy percent developed an oronasal fistula. An alveolar bone graft was performed in 83%, and 53.3% underwent Le Fort osteotomy. Thirty-six percent required a pharyngeal flap, with good speech results. The median number of times general anesthesia was used among all the interventions considered was 5.5 (4.25–6). Conclusions: This study presents the long-term results of using the inverse Malek procedure to treat children with a bilateral cleft lip and palate. It is shown that this is related to a high risk of developing a fistula, but has good long-term speech results.

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The Mandibular Ramus: An Alternative Donor Site for Secondary Alveolar Bone Grafting in Clefts of the Alveolus

Cited by 5 publications

References 5 publications

A 3-Dimensional Evaluation of Bone Density in Alveolar Cleft Grafting Methods: Bone Substitutes Versus Autologous Bone

A 3-Dimensional Evaluation of Bone Density in Alveolar Cleft Grafting Methods: Bone Substitutes Versus Autologous Bone

Unilateral Cleft lip and Palate: Long-Term Results of the Malek Technique

What We Learned from Performing the Inverse Malek Procedure to Repair Bilateral Cleft Lips and Palates: A Single-Center Retrospective Study

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