Percutaneous iliac bone grafting of secondary alveolar clefts

Secondary bone grafting of residual alveolar clefts has become an integral part of the comprehensive care of children born with facial clefting. Although indications and timing may remain somewhat controversial, bone grafting during the period of mixed dentition has gained widespread acceptance. A number of bone graft sites have been proposed; each has its enthusiastic proponents. We believe that cancellous bone harvested from the ilium provides optimal material to achieve successful alveolar bone grafting. Unfortunately, this site has been associated with significant morbidity, primarily pain, which can prolong a patient's hospitalization. We relate our experience from two centers encompassing 24 patients who underwent percutaneous harvesting of corticocancellous bone grafts from the ilium. With this method we were successful in obtaining adequate quantities of corticocancellous bone with the Craig bone biopsy needle regardless of the cleft size. Each patient was able to ambulate without difficulty within hours of surgery. We are currently performing alveolar bone grafting as an outpatient procedure employing this technique. In addition, we believe this method has particular usefulness in Third World countries.