The effects of gingivoperiosteoplasty following alveolar molding with a pin-retained Latham appliance versus secondary bone grafting on midfacial growth in patients with unilateral clefts

Damir B Matic, Stephanie M Power
Plastic and Reconstructive Surgery 2008, 122 (3): 863-70; discussion 871-3

BACKGROUND: Gingivoperiosteoplasty is used for early closure of the alveolar cleft in patients with complete clefts of the primary palate. However, its impact on long-term facial development remains unclear. The purpose of this study was to evaluate the effects of gingivoperiosteoplasty following alveolar molding with a pin-retained Latham appliance on long-term midfacial growth and compare it with secondary bone grafting.

METHODS: A retrospective review identified patients born with unilateral complete clefts of the primary and secondary palate. All patients were past the age of permanent canine tooth eruption. Standard cephalometric landmarks were plotted and analyzed by a blinded rater. Patients were divided into two groups based on type of alveolar closure: secondary bone grafting-only or gingivoperiosteoplasty-total. The gingivoperiosteoplasty-total group was further subdivided based on gingivoperiosteoplasty clinical outcomes. Statistical analyses first controlled for age and then for age and palate repair.

RESULTS: The average age of the patients was 14.7 years. Radiographs were obtained for 54 patients (gingivoperiosteoplasty-total, n = 38; secondary bone grafting-only, n = 16). The gingivoperiosteoplasty-total group demonstrated decreased maxillary height (p = 0.005) and protrusion (p = 0.001) versus secondary bone grafting only. Dentoalveolar occlusion was not statistically different between groups.

CONCLUSIONS: Gingivoperiosteoplasty following alveolar molding with a pin-retained Latham appliance resulted in decreased maxillary protrusion and height compared with secondary bone grafting only. These differences were found irrespective of the technique of palatoplasty. This technique resulted in similar growth patterns as documented following primary bone grafting. Secondary bone grafting therefore remains the authors' surgical approach to the cleft alveolus.

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