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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2009 April;20(1):13-20
Long term results after early secondary gingivo-alveolo-plasty: ossification and growth in unilateral cleft lip and palate patients
Meazzini M. C. 1, Garattini G. 2, Rossetti G. 1, Ferrari M. 1, Venturini F., Brusati R. 1
1 Regional Center for CLP Department of Maxillo-Facial Surgery University of Milan, Milan, Italy
2 Department of Orthodontics San Paolo Hospital, Milan, Italy
Aim. The Milan surgical protocol from 1988 includes lip, nose and soft palate repair at 6-9 months of age and closure of the hard palate and alveolus with an early secondary gingivo-alveolo-plasty (ESGAP) at 18-36 months. The aim of this study was to evaluate the alveolar ossification and the long-term maxillary growth in unilateral cleft lip and palate (UCLP) patients who have undergone ESGAP. Growth was compared with that of a sample treated before 1988, by the same surgeon, with a surgical protocol that differs only for the method and the timing of alveolar closure, by secondary bone grafting instead of ESGAP and also with a sample of CLP patients from the Oslo CLP Center.
Methods. Regarding ossification the samples consisted of panoramic x-rays of UCLP in permanent dentition. For the growth assessment the samples consisted of lateral X-ray cephalograms of the UCLP ESGAP sample, of the UCLP bone graft sample and the Oslo CLP center sample.
Results. It seems that ESGAP allows for an excellent alveolar ossification, but patients show an inhibition of maxillary growth compared to the secondary bone graft group and to the Oslo group.
Conclusion. Although ESGAP allows for early repair of the alveolus together with palate repair, thus eliminating in all patients the need for secondary bone grafting, it seems to have an inhibiting influence on maxillary growth which increases the need for Le Fort I osteotomies. It is fair to remind, though, that, even with an adjunctive Le Fort I osteotomy, ESGAP allows to keep the total number of surgeries down to three, instead of most European protocols (4-5 surgeries).