Primary, Early Bone Grafting in Complete Clefts of the Lip and Palate: A Follow-up Study of 53 Cases

Abstract

Fifty-three patients with complete unilateral and bilateral cleft lip and palate between the ages of 5 1/2 and 13 1/2 years have been followed up. Following preoperative jaw orthopedic treatment, when indicated, these cases were operated with lip closure and bone grafting with four mucoperiosteal flaps as described by Nordin (1960) and Bäckdahl & Nordin (1961). In the 14 bilateral cases this operation was done in two stages, one side at a time, in this series. At the follow-up, facial appearance, hearing, speech assessment, some facial angles and incidence of crossbites were examined. In the 39 unilateral cleft cases, 80% had an acceptable appearance while 20% needed secondary surgery of the lip and nose as rated independently by four doctors. In the 14 bilateral cases 50% needed secondary operation of the lip and nose. Speech assessment in the bone-grafted group was good or superior to that in a non-bone-grafted group of patients with clefts of the primary and the secondary palate. Open nasality and consonant articulations were also taken into consideration. No permanent hearing impairment was noted in these patients although they are prone to chronic ear diseases. No serious maldevelopment of the facial skeleton was noted in our study following primary, early bone grafting. The incidence of crossbite was comparatively low. This type of treatment is continuing at our centre since the results are promising. Comparison of similar studies from other centres with long-term follow-ups are called for.