Three-dimensional Assessment of Autologous Calvarial Bone Grafting for Alveolar Clefts Reconstruction in Pediatric Population: A Retrospective Study.

Reconstruction of alveolar clefts using cancellous bone graft is associated with a high rate of resorption. The aim of this study was to evaluate the osseointegration capacity of cortical calvarial bone grafting using 3-dimensional imaging assessment for alveolar cleft reconstruction in pediatric population.All alveolar bone grafting procedures performed between January 2015 and October 2017 in the maxillofacial surgery department of Lille University Hospital were included. All patients were evaluated clinically and by 3-dimensional imaging before bone grafting and at 3 months after surgery. Cleft and bone graft volumes were assessed using Horos software, v. 3.3.5, through a segmentation process. The bone filled ratio at 3 months after surgery was calculated. A total of 48 alveolar bone grafting procedures were performed in 37 patients: 3 unilateral cleft lip and alveolar, 20 unilateral cleft lip and palate, and 25 bilateral full cleft lip and palate (3 patients had only unilateral surgery). The mean bone filled ratio was 72.27%±23.65%, 81% for unilateral cleft lip and alveolus, 75.4%±20.6 for unilateral cleft lip and palate, and 65.5%±30 for bilateral complete cleft lip and palate ( P =0.1981). Calvarial bone grafting seems to be a relevant alternative to other donor sites for alveolar cleft reconstruction.

Facial morphology changes after total maxillary setback osteotomy.

PURPOSE: To evaluate the morphologic outcome after total maxillary setback osteotomy (TMSO) in dentofacial Class II deformity patients with marked upper jaw prognathism. PATIENTS AND METHODS: The assessments of 9 patients before and after TMSO were compared. The evaluation was based upon x-ray superimpositions and standardized photographic comparison. TMSO was performed through a conventional Le Fort I operation with resection of the inferior end of the pterygoid processes. RESULTS: All patients presented with marked upper jaw prognathism initially and have had a bimaxillary surgery with a mean maxillary setback of 3.1 mm. All patients ended in Class I occlusion after at least 1-year of follow-up. An opening of the nasolabial angle (mean 8.9 degrees) was noted for all but 2 patients. At the same time, the suborbital profile was nicely modified as a result of substantial heightening of the prezygomatic soft tissues in all patients, even without vertical maxillary intrusion. CONCLUSIONS: These results challenge the notion of unavoidable facial alteration commonly associated with upper setbacks. TMSO allows combining satisfactory functional and cosmetic results for a number of carefully selected patients. Pronounced maxillary protrusion with acute nasolabial angle is a prerequisite. The release of the deforming strains of the dysmorphosis upon the midface will improve the suborbital profile. Bimaxillary surgery is recommended to leverage the setback and the opening of the naso-labial angle.