Nostril Base Augmentation Effect of Alveolar Bone Graft

Woojin Lee,Hyung Joon Park,Dong Hyeok Shin,엄기일 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.5

Background The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft. Methods Records of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm’s-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT. Results Significant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001). Conclusions An alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.

Nostril Base Augmentation Effect of Alveolar Bone Graft

Lee, Woojin,Park, Hyung Joon,Choi, Hyun Gon,Shin, Dong Hyeok,Uhm, Ki Il Korean Society of Plastic and Reconstructive Surge 2013 Archives of Plastic Surgery Vol.40 No.5

Background The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft. Methods Records of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm's-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT. Results Significant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001). Conclusions An alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.

Secondary bone grafting for alveolar clefts: surgical timing, graft materials, and evaluation methods

Kim, Junhyung,Jeong, Woonhyeok Korean Cleft Palate-Craniofacial Association 2022 Archives of Craniofacial Surgery Vol.23 No.2

Alveolar cleft belongs to the spectrum of cleft lip and/or palate, affecting 75% of cleft lip/palate patients. The goals of alveolar cleft treatment are stabilizing the maxillary arch, separating the nasal and oral cavities, and providing bony support for both erupting teeth and the nasal base via the piriform aperture. Secondary alveolar bone grafting is a well-established treatment option for alveolar cleft. Secondary alveolar bone grafting is performed during the period of mixed dentition using autologous bone from various donor sites. There are several issues relevant to maximizing the success of secondary alveolar bone grafting, including the surgical timing, graft material, and surgical technique. In this study, we reviewed issues related to surgical timing, graft materials, and evaluation methods in secondary alveolar bone grafting.

양측 치간 신연골형성술을 이용한 넓은 치조열의 치료

김석화,유현석,김재찬 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.3

Alveolar bone graft has several benefits such as bony support to teeth adjacent to the cleft, bony matrix for eruption of teeth in the line of the cleft, stability of maxillary segments, and elimination of oronasal fistula. But wide gap alveolar cleft is difficult to treat using bone graft, because a large amount of bone harvesting is required and complete closure by using local attached gingiva is difficult to achieve. Therefore we introduced bilateral interdental distraction osteogenesis method to treat patients who had wide alveolar gap. From August, 1999 to April, 2000, we treated 4 patients of unilateral complete alveolar cleft(aged 10-4 years) by using this method. Distraction device was fitted to the supporting teeth. And then horizontal osteotomy was performed bilaterally at the level of 3-5 mm away from the dental roots, vertical osteotomy was performed between the second premolar and the first molar. Simultaneously, oronasal fistula was repaired. After the latency period of 3 to 5 days, we distracted bilateral distal segments as distraction protocol. After completing distraction, device was left for about 4 weeks before initiating the post-operative orthodontic treatment. The alveolar bone graft and buccal mucosa local flap were not required in these patients. By using interdental distraction osteogenesis, wide gap alveolar cleft was treated effectively.

Three-dimensional evaluation of alveolar changes induced by nasoalveolar molding in infants with unilateral cleft lip and palate: A case-control study

Merve Altay Burgaz,Derya Germec Cakan,R. Burcu Nur Yılmaz 대한치과교정학회 2019 대한치과교정학회지 Vol.49 No.5

Objective: The objectives of this study were to evaluate linear and volumetric alveolar changes induced by nasoalveolar molding (NAM) in infants with complete unilateral cleft lip and palate (UCLP) and compare the maxillary dimensions after NAM with the normal dimensions in infants without clefts. Methods: A total of 26 infants with UCLP treated by NAM (mean age before and after NAM: 14.20 ± 8.09 days and 118.16 ± 10.06 days, respectively) comprised the treatment group, while 26 infants without clefts (mean age: 115.81 ± 8.71 days) comprised the control group. Changes in the maxillary dimensions following NAM were measured on three-dimensional models using Mimics software, version 17.0. Results: During NAM, there was a decrease in the cleft widths, maxillary arch depths, and rotation of the greater segment. While the anterior alveolar arch width exhibited a significant decrease, the posterior arch width was mostly maintained. There were no changes in the anterior vertical deviations of the alveolar segments. The alveolar crest lengths, arch circumference, and bilateral posterior volumetric measures exhibited an increase. After NAM, the anterior arch width was comparable between the treatment and control groups, whereas the posterior arch width and anterior vertical deviations were greater in the treatment group than in the control group. The maxillary arch depths, alveolar crest lengths, and maxillary volumes were smaller in the NAM group than in the control group. Conclusions: During NAM in infants with UCLP, the cleft width and anteroposterior and transverse alveolar dimensions exhibited a decrease while the vertical dimensions were maintained. Compared with infants without clefts, those with UCLP treated by NAM exhibited sagittal and vertical alveolar growth deficiencies and tissue insufficiency.

가토의 치조열 모델에서 골수 흡인물이 자가뼈 이식술에 미치는 효과

배성근,정호윤,조병채,양정덕,박미영,이상윤 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.5

Purpose: Alveolar bone grafting has become an essential process in the treatment of alveolar cleft patient for stabilization of the maxillary arch, elimination of oronasal fistula, the reconstruction of the soft tissue nasal base support, and creation of bony support for tooth eruption for implant. The use of Autologous iliac cancellous bone is preferable because it enables to use adequate quantity and its high osteoinductive potential. However, even with iliac bone, insufficient osteoregeneration or absorption occurs due to several factors such as the patient's age, cleft width, functional stress, and others. In order to increase osteoregeneration where the iliac bone is placed, the present study is associated with bone marrow aspirate(BMA).The experimental study evaluated the efficacy of osteoregeneration in normal cleft rabbits when alveolar bone grafting was performed with autologous iliac corticocancellous bone. Methods: Twenty-four New Zealand White rabbits were divided randomly into 2 groups(BMA, control). All animals underwent harvesting of corticocancellous bone graft from the right posterior iliac crest via standard surgical technique. 1㎖ of BMA were obtained by scraping the needle and aspirate with 10㎖L syringe from the contralateral iliac bone wall. The muco-periosteal flap on the palate was elevated. A mixture of Equal bone’s volumes with BMA and saline as its control was inserted into the cleft. Animals were sacrificed in 2, 4, and 8 weeks and maxilla was harvested for dental peri-apical X-ray, bone matrix density (BMD), and histologic analysis. Results: BMD of regenerated bone to the cleft in the rabbits was higher than that of the control rabbits. X-ray, histologic analysis showed that increased osteoregeneration and low absorption rate were observed in the BMA group. Conclusion: Our experimental study shows BMA enhanced the osteoregeneration and survival rate of alveolar bone grafting. BMA is easy to extract and cost-time effective. So it can be an effective enhancers for bone grafting mixtures.

치조열 재건을 위한 다양한 골이식 방법 : 문헌 고찰

이환규,김준영,김성룡,박진후,정휘동,정영수 대한치과의사협회 2022 대한치과의사협회지 Vol.60 No.10

Alveolar cleft is a congenital anomaly with a frequency of 0.18-2.50 per 1,000 births, which invades the bone of maxillary arch. Iliac crestal bone graft, considered as the gold standard for treatment of alveolar cleft, is a commonly used material due to its abundant mass, ease of harvesting, and the advantages of simultaneous operation with alveolar cleft reconstruction surgery. Despite many advantages of Iliac crestal bone graft, many studies have been conducted on alternative and additional materials for secondary alveolar bone graft in consideration of the disadvantages of iliac crest bone graft. Autogenous bone grafts from other donor sites, such as cranium, mandible and tibia can be used as an alternative with lower morbidity and lower bone resorption. Bone-tissue engineering strategies such as scaffolds, growth factors have also shown promising results in treatment of alveolar cleft. In addition, the use of Platelet-Rich-Fibrin/Plasma with abundant growth factors and osteoinducibility can increase bone maintenance and achieve better results. Therefore, here we review the various bone graft methods used in reconstruction of alveolar cleft.

치은 골막 피판과 장골이식을 이용한 이차성 치조열의 교정: 경피 생검 바늘의 이용

이택종,고경석,한병주,엄진섭 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

Correction of alveolar cleft with bone grafting has become a well-established step in the integral management of cleft lip and palate patients. Secondary bone graft at mixed dentition is a widely accepted protocol and iliac bone graft is recommended as the gold standard by a multitude of cleft centers. However, grave morbidities of the iliac donor site have discouraged cleft surgeons from adopting this reliable method. In this study, percutaneous bone biopsy set was used to avoid the morbidities of conventional iliac bone graft. Iliac bone graft was performed on 20 patients with alveolar cleft during the period from January 1995 to February 1999. The tube saw of the bone biopsy set was introduced through a small incision of less than 1 cm, and cancellous bone cores were harvested from the iliac crest. After the pericoronal incision, a wide gingival mucoperiosteal flap was elevated at both sides of the cleft. A soft tissue pocket that was created by closure of the nasal and palatal lining was filled with harvested bone cores. Medial transposition and water-tight closure of both gingival mucoperiosteal flaps provided coverage of the bone graft. During the follow-up period from 5 to 50 months(mean, 29 months), completion of the goals of the alveolar bone graft was observed. There was no serious complication except for one case the exposure of the bone graft, and this was resolved spontaneously. Bone harvest with a percutaneous bone biopsy set enables early ambulation by reducing postoperative pain, and it may be faster and simpler than any other method introduced so far. Furthermore, blood loss was minimal, while the scar was small and acceptable. Iliac bone graft with percutaneous bone biopsy is a reliable method for correction of the alveolar cleft and it has many advantages over conventional iliac bone graft and other sources of bone.

구순구개열 환자의 골격 기형 수술 후 안정성 : 문헌 고찰

박지호(Jiho Park),이환규(Hwangyu Lee),김준영(Jun-Young Kim),박진후(Jin Hoo Park),정영수(Young-Soo Jung),정휘동(Hwi-dong Jung) 대한구순구개열학회 2020 대한구순구개열학회지 Vol.23 No.2

Successful treatment of cleft lip and palate requires a high level of understanding of the complexity of anomalies and insights for predicting the four-dimensional change of growth. In addition, the surgeon needs to take responsibility for the life-long step-by-step operation that has profound effect on the patient. Alveolar cleft, which occurs in about 75% of cleft lip and palate patients, cannot be recovered without surgical treatment and can cause complications in various areas. However, there remains a lot of debate about the timing of the treatment of alveolar cleft. As a result of an intrinsic defect or previous surgery, patients with cleft lip and palate develop maxillary deficiency in all 3 dimensions with constricted maxillary arch. Therefore maxillary advancement surgery is indicated in about most patients with cleft lip and palate undergoing orthognathic surgery. Therefore, the authors will introduce the consensus of treatment and principles that must be observed in corrective surgery for skeletal abnormalities occurring in cleft lip and palate patients through literature review.

편측성 치조. 구개 파열 환자에서 골 이식술의 치험레

이창곤,진병로,이명진,배윤호,박재현,이희경 영남대학교 의과대학 1991 Yeungnam University Journal of Medicine Vol.8 No.1

We obtained successful functional and esthetic results by grafting of iliac marrow- cancellous bone in 2 cases of alveolar-palatal cleft patients. Bone graft of alveolar-palatal clefts provide bony supprt to adjacent teeth of cleft area, prevented from relapse of orthodontic arch expansion, closure of oroantrtal fistula and improvement of speech problem. 1. In one case, extraction of upper right central incisor that was little bone support, alignment of rotated teeth and expansion of collapsed arch segment were done with preortodontic treatment. The other case, Bone grafting was done after removal of prosthesis with no preorthodontic treatment. 2. After mucopreiosteal incision in cleft area. The mucosal flap of labial area, palate and nose were separation and the raised nasal mucosa was sutured for closure of oroantral fistula. Then, the iliac marrow-cancellous bones were grafted to cleft site. 3. After 6 months of operation, we had seen the new bone deposition to cleft site in dental radiograph and prostheic treatments of missing teeth were done.