Skeletal reconstruction in cleft palate patients

Improved management techniques of secondary cleft palate deformities are steadily evolving. The year's literature under review focuses mostly on the various methods available for establishing a complete and stable dental arch. Bone from the mandibular symphysis seems to offer a more reliable source of autogenous bone than do other sites, although if the residual cleft is large, this site may not provide sufficient bone. The optimum time to graft the alveolus appears to be after the incisors have erupted, but before the canine root has fully formed and the crown broken through the mucosa. Mucoperiosteal flaps give better long-term results than do mucosal flaps. Long-term stability of the alveolar segments may be achieved with extended bridges, and the use of rigid internal fixation may offer better three dimensional stability of the maxilla following advancement and inferior repositioning. Pharyngeal flaps have a detrimental effect on stability of the maxilla after advancement, although they may have a beneficial effect on velopharyngeal function after maxillary surgery.