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Yamanishi T, Arimura Y, Kirikoshi S, Hara T, Nishio T, Seikai T, Uematsu S, Nishio J. Clinical outcomes of gingivoperiosteoplasty for unilateral cleft lip and palate performed in early childhood. J Plast Reconstr Aesthet Surg 2024; 97:268-274. [PMID: 39173578 DOI: 10.1016/j.bjps.2024.07.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/24/2024]
Abstract
Conventional gingivoperiosteoplasty (GPP) performed during infancy adversely affects maxillary development. However, the outcomes of this procedure in early childhood have rarely been reported. Therefore, we examined the postoperative outcomes of GPP conducted in patients aged 1.5 years with unilateral cleft lip and palate (UCLP). This study included 87 non-syndromic patients with complete UCLP who had undergone early two-stage palatoplasty during the 1999-2004 period. The protocol comprised soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age. In the GPP group (n = 34), we introduced the GPP procedure during hard palate closure; in the non-GPP group (n = 53), the labial side of the alveolar cleft remained intact. We examined computed tomography images taken at 8 years of age to observe bone formation at the alveolar cleft site. We also conducted cephalometric analysis to examine maxillary development at 12 years of age. Bone bridges at the alveolar cleft site were observed in 92% and 5.6% of the GPP and non-GPP groups, respectively. Moreover, 56% of the GPP group did not require secondary alveolar bone grafting (sABG), whereas all the patients in the non-GPP group underwent sABG. No statistically significant differences were noted in the maxillary anteroposterior length (GPP: 45.5 ± 3.7 mm, non-GPP: 45.9 ± 3.5 mm, p = 0.67) and sella-nasion-point A angle (GPP: 75.6 ± 4.5°, non-GPP: 73.8 ± 12.6°, p = 0.49). This study's findings suggest that GPP performed at 1.5 years of age minimises the necessity of sABG and does not exert a negative influence on maxillofacial development.
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Affiliation(s)
- Tadashi Yamanishi
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan.
| | - Yuki Arimura
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan; Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Kita-ku, Okayama 700-8558, Japan
| | - Shoko Kirikoshi
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Graduate School of Dental Medicine, Faculty of Dental Medicine, Hokkaido University, Kita 13 Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8586, Japan
| | - Takayuki Hara
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan
| | - Takahiro Nishio
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan
| | - Tetsuya Seikai
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Graduate School of Dental Medicine, Faculty of Dental Medicine, Hokkaido University, Kita 13 Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8586, Japan
| | - Setsuko Uematsu
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan
| | - Juntaro Nishio
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka 594-1101, Japan
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El Danaf AA, Al-Ahmady HH, Eldanaf HA, Soliman HA, Elhelw MH, Khalil MF, Rizk IA, Donia MS. Alveolar Oral Layer Repair by Periosteal Grafts versus Maxillary Flaps and Gingivoperiosteoplasty: Techniques and Follow-up to Adolescence. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5633. [PMID: 38415103 PMCID: PMC10898659 DOI: 10.1097/gox.0000000000005633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/09/2024] [Indexed: 02/29/2024]
Abstract
Background Alveolar periosteoplasty during primary repair of cleft lip is still a topic of debate due to the fear exacerbating maxillary retrusion. The authors present their experience with early closure of alveolar clefts. The study aims to analyze gingivoperiosteoplasty (GPP) by comparing the use of locoregional flaps versus distant grafts for reconstruction of the lower layer of the primary palate cleft. Methods Seventeen infants underwent 22 alveolar cleft repairs. After nasal floor repair by nasal mucoperiosteum, the oral layer was repaired by maxillary or gingival periosteal flaps in seven patients with alveolar clefts less than or equal to 6 mm wide, and tibial or pericranial periosteal grafts in 10 patients with wider clefts. At teenage years, crossbites in three flap-GPP and three graft-GPP patients were compared with nine older adolescents without primary GPP. Results Alveolar clefts were perfectly sealed. Radiographs during the early 3 postoperative years showed new bone formation more posteriorly extended in patients who underwent graft-GPP. Teeth eruption and alveolar rigidity at the mixed dentition age eliminated the need for secondary bone grafting. The anterior crossbites in adolescent patients ranged between -2 and -14 mm; crossing was relatively smaller in patients with a younger age and without cleft palate. The mean crossbite was 7.2 mm in the six teenagers and 9.6 mm in the control cases. Conclusions Graft-GPP may be a good alternative to flap-GPP, particularly for wide alveolar cleft repair. Maxillary retrusion is aggravated in patients with cleft palate and older age at assessment. GPP may not increase crossbite.
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Affiliation(s)
- Ahmed A. El Danaf
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Hatem H. Al-Ahmady
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Girls’ Branch, Al Azhar University, Cairo, Egypt
| | - Heba A. Eldanaf
- Restorative and Dental Materials Department, Oral and Dental Research Division, National Research Centre, Giza, Cairo, Egypt
| | - Helmy A. Soliman
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Moustafa H. Elhelw
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Maurice F. Khalil
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Ibrahim A. Rizk
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Mohamed S. Donia
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
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