Segmental Maxillary Osteotomy to Close Wide Alveolar Clefts

Publication date: Available online 26 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Alexander T. Wilson, Robin T. Wu, Rajendra Sawh-Martinez, Derek M. Steinbacher

Abstract

Introduction: Wide alveolar clefts are challenging to treat and are often associated with a higher chance of failure requiring repeated bone grafts. Even if successful, an excessively large cleft leads to a wide edentulous space, and patients are faced with prolonged orthodontic treatment. We present a series of large alveolar clefts closed with the aid of segmental maxillary osteotomies. Cases of alveolar clefts treated by segmental maxillary osteotomy were reviewed from 2014-2016. Preoperative and postoperative CTs were analyzed to assess alveolar gap and bone fill. Demographics, diagnosis, and operative technique were reviewed and described. 10 alveolar fistulae were addressed, using 6 segmental osteotomies in 6 patients. 66% were bilateral cases. 4 were female and 2 were male with an average age of 12.6 years. Average preoperative cleft width was 14.2mm on CT scan. Postoperatively, all clefts were successfully closed and no adverse effects were observed. Segmental maxillary osteotomy with concurrent bone grafting and fistula closure is an effective approach to treat excessively wide alveolar clefts. This enables a prudent dental substitution/prosthodontic plan, while minimizing prolonged orthodontia, in addition to achieving the traditional goals of alveolar bone grafting (stabilizing the maxillary arch, closing fistulae, and permitting canine eruption).

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