Teaching model for closure of oronasal fistula and bone grafting of the maxilla

Custom-Made Cleft Palate Models to Teach V-Y Pushback Palatoplasty

ABSTRACT

We developed custom-made cleft palate (CP) models to teach V-Y pushback palatoplasty, with a focus on design and mucoperiosteal elevation.A model (23 cm wide, 30 cm long, and 13 cm high) was made using silicone (model 1; M1). On the palate of a skull model, 2 layers of colored rubber clay were applied to represent the superficial oral mucoperiosteum and deep nasal mucosa (model 2; M2). From the greater palatine foramen, threads of dental floss were inserted inside the clay, representing the greater palatine artery. In a workshop, a mouth gag was applied on M1, and participants designed 2-flap palatoplasty and 4-flap palatoplasty. On the palate of M2, incisions were made with a #15 blade. On M2, a mucoperiosteal flap (rubber clay over the hard palate) was elevated using a periosteal elevator, avoiding injury to the dental floss mimicking the greater palatine artery. Six participants were recruited for the workshop and were asked to rate their satisfaction with the outcome on a Likert scale.For CP design, participants answered that they had learned useful knowledge from this workshop, reflecting a significant improvement (4.0 ± 1.1 for incomplete CP, 4.2 ± 1.2 for complete CP). They became confident in this skill after the workshop (4.2 ± 0.8 for incomplete CP, 3.8 ± 0.8 for complete CP). For cleft mucoperiosteal flap elevation, they likewise learned useful knowledge (4.7 ± 0.5 for incomplete CP, 4.5 ± 0.5 for complete CP) and became confident in this skill (3.8 ± 0.8 for incomplete CP, 4.0 ± 0.6 for complete CP.)These models can be useful for V-Y pushback palatoplasty training for medical personnel.

Preliminary report of two-stage secondary alveolar bone grafting for patients with bilateral cleft lip and palate

OBJECTIVE

To overcome the difficulties of one-stage secondary alveolar bone grafting for patients with bilateral cleft lip and palate (BCLP) who have a broad alveolar cleft, the value of two-stage alveolar bone grafting was examined.

PATIENTS

Three patients (2 girls and 1 boy) with BCLP were treated by two-stage alveolar bone grafting. The procedure consisted of a first-stage surgery (mean age 8 year 6 months +/- 7.8 months), which consisted of alveolar bone grafting for one side of the BCLP, and second-stage surgery for the contralateral side several months later. For the postoperative assessment, radiographs of the operated site were examined.

RESULTS

The average amount of implanted bone per operation and per patient was 6.8 +/- 1.1 g and 13.7 +/- 1.0 g, respectively. Postoperative clinical and radiographic examinations revealed that an appreciable alveolar bone ridge had formed, and there were no major complications.

CONCLUSIONS

Two-stage alveolar bone grafting, which makes it possible to reduce the amount of implanted bone, could be an optional surgical procedure for patients with BCLP and a broad alveolar cleft.