Subscribe to RSS
DOI: 10.1055/s-2007-979283
Direct Gingivoperiosteoplasty with Palatoplasty
Publication History
Publication Date:
21 May 2007 (online)
![](https://www.thieme-connect.de/media/fps/200702/lookinside/thumbnails/10.1055-s-2007-979283-1.jpg)
ABSTRACT
Gingivoperiosteoplasty creates a mucoperiosteal bridge across the alveolar cleft associated with cleft lip and palate. The subperiosteal tunnel allows for bone generation in the absence of bone grafting in young patients. The original procedure required wide maxillary subperiosteal dissection and flap rotation but has since evolved along with techniques to narrow the alveolar cleft toward limited dissection and direct closure. Multiple studies reveal superior facial growth parameters, particularly vertical maxillary growth, when compared with primary bone grafting typically performed within the first year of life and a reduced need for later secondary bone grafting. Most centers that perform gingivoperiosteoplasty do so in conjunction with primary lip closure after initial narrowing of the cleft with presurgical orthopedics. We present our method of direct gingivoperiosteoplasty performed simultaneously with palatoplasty after alveolar cleft narrowing without presurgical orthopedics via a two-stage lip repair. Preliminary data suggest bone growth capable of supporting tooth eruption without significant growth disturbances in a majority of patients treated with this protocol.
KEYWORDS
Gingivoperiosteoplasty - periosteoplasty - cleft palate - cleft lip - palatoplasty - alveolar cleft
REFERENCES
- 1 Skoog T. The use of periosteal flaps in the repair of clefts of the primary palate. Cleft Palate J. 1965; 2 332-339
- 2 Skoog T. The use of periosteum and surgicel for bone restoration in congenital clefts of the maxilla. A clinical report and experimental investigation. Scand J Plast Reconstr Surg. 1967; 1 113-130
- 3 Ritsila V, Alhopuro S, Gylling U, Rintala A. The use of free periosteum for bone formation in congenital clefts of the maxilla. A preliminary report. Scand J Plast Reconstr Surg. 1972; 6 57-60
- 4 Ritsila V, Alhopuro S, Rintala A. Bone formation with free periosteal grafts in reconstruction of congenital maxillary clefts. Ann Chir Gynaecol. 1976; 65 342-344
- 5 Rintala A E, Ranta R. Periosteal flaps and grafts in primary cleft repair: a follow-up study. Plast Reconstr Surg. 1989; 83 17-22
- 6 Massei A. Reconstruction of cleft maxilla with periosteoplasty. Scand J Plast Reconstr Surg. 1986; 20 41-44
- 7 Millard D R, Latham R A. Improved primary surgical and dental treatment of clefts. Plast Reconstr Surg. 1990; 86 856-871
- 8 Ross B. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J. 1987; 24 3-89
- 9 Brattstrom V, Mcwilliam J, Larson O, Semb G. Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes. I. Maxillary development. Scand J Plast Reconstr Surg Hand Surg. 1991; 25 259-267
- 10 Smahel Z, Mullerova Z, Horak I. Facial development in unilateral cleft lip and palate prior to the eruption of permanent incisors after primary bone grafting and periosteal flap surgery. Acta Chir Plast. 1996; 38 30-36
- 11 Grisius T M, Spolyar J, Jackson I T et al.. Assessment of cleft lip and palate patients treated with presurgical orthopedic correction and either primary bone grafts, gingivoperiosteoplasty, or without alveolar grafting procedure. J Craniofac Surg. 2006; 17 468-473
- 12 Sameshima G T, Smahel Z. Facial growth in adulthood after primary periosteoplasty or primary bone grafting in UCLP. Cleft Palate Craniofac J. 2000; 37 379-384
- 13 Murthy A S, Lehman J A. Evaluation of alveolar bone grafting. Cleft Palate Craniofac J. 2005; 42 99-101
- 14 Smahel Z, Mullerova Z. Effects of primary periosteoplasty on facial growth in unilateral cleft lip and palate: 10-year follow-up. Cleft Palate J. 1988; 25 356-361
- 15 Sameshima G T, Banh D S, Smahel Z, Melnick M. Facial growth after primary periosteoplasty versus primary bone grafting in unilateral cleft lip and palate. Cleft Palate Craniofac J. 1996; 33 300-305
- 16 Wood R J, Grayson B H, Cutting C B. Gingivoperiosteoplasty and midfacial growth. Cleft Palate Craniofac J. 1997; 34 17-20
- 17 Lukash F N, Schwartz M, Grauer S, Tuminelli F. Dynamic cleft maxillary orthopedics and periosteoplasty: benefit or detriment?. Ann Plast Surg. 1998; 40 321-326
- 18 Lee C TH, Grayson B H, Cutting C B et al.. Prepubertal midface growth in unilateral cleft lip and palate following alveolar molding and gingivoperiosteoplasty. Cleft Palate Craniofac J. 2004; 41 375-380
- 19 Santiago P E, Grayson B H, Cutting C B et al.. Reduced need for alveolar bone grafting by presurgical orthopedics and primary gingivoperiosteoplasty. Cleft Palate Craniofac J. 1997; 35 77-80
- 20 Renkielska A, Wojtaszek-Slominska A, Dobke M. Early cleft lip repair in children with unilateral complete cleft lip and palate. A case against primary alveolar repair. Ann Plast Surg. 2005; 54 595-597
- 21 Berkowitz S, Mejia M, Bystrik A. A comparison of the effects of the Latham-Millard procedure with those of a conservative approach for dental occlusion and facial aesthetics in unilateral and bilateral complete cleft lip and palate: part I. Dental occlusion. Plast Reconstr Surg. 2004; 113 1-18
- 22 Tomanova M, Mullerova Z. Growth of the dental arch in patients with complete unilateral cleft lip and palate after primary periosteoplasty. Acta Chir Plast. 1994; 36 119-123
- 23 Hellquist R, Svardstrom K, Ponten B. A longitudinal study of delayed periosteoplasty to the cleft alveolus. Cleft Palate J. 1983; 20 277-288
- 24 Smith W P, Markus A F, Delaire J. Primary closure of the cleft alveolus: a functional approach. Br J Oral Maxillofac Surg. 1995; 33 156-165
- 25 Brusati R, Mannucci N. The early gingivoalveoloplasty. Preliminary results. Scand J Plast Reconstr Surg Hand Surg. 1992; 26 65-70
Sherard A TatumM.D.
Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
750 East Adams Street, Syracuse, NY 13210