The Long-term Results of Early Rib Bone Graft in the Alveolar Cleft

Lee, Siwoo; Kim, Sukwha; Kim, Jaechan; Park, Chulgyu

Abstract

There are controversies in timing of the bone graft in the alveolar cleft. In many hospitals, secondary alveolar bone graft is performed and many surgeons or orthodontists maintain that primary or early bone graft have several disadvantages such as maxillary retrusion and poor maxillary development. But Nylen et al. and Rosenstein have reported favorable results. We treated 4 patients of unilateral complete alveolar cleft using early rib bone graft. Presurgical infantile orthodontics were done. At 12 weeks of age the cleft lip was corrected. The repaired lip has molding effect on the greater segment toward the lesser. When good arch alignment had been obtained after the molding period, bone graft was inserted between the segments. We analyzed these 4 patients by using cephalometric analysis, panoramic, occlusal, periapical radiograph and 3D-CT at the age of 12 years 10 months in average and evaluated the survival of the bone graft, facial growth and tooth eruption. In all patients, the grafted rib bones were absorbed partially. The 3 patients without cleft palate have normal maxillomandibular relation but the eruption of teeth was disturbed. The other patient with the cleft palate shows severe maxillary retrusion and disturbed tooth eruption including delayed eruption, underdevelopment and malposition. The additional iliac bone graft were performed in 2 of the patients and is scheduled in the other 2 patients In conclusion early rib bone graft in the alveolar cleft was not successful because of absorption which caused disturbance of teeth eruption.