The reconstruction of anterior residual bone defects in patients with cleft lip, alveolus and palate. A review.

A re-evaluation is presented more than a decade after the 1973 review by Koberg of bone grafting in cleft palate. The various indications for, and aims of the procedure, are enumerated. The optimal age for grafting is discussed as well as operative procedures. Results of a few more detailed studies are included in the review. In the conclusion the present shifts of emphasis are mentioned: An in depth analytical study of numerical comparisons between the many studies covering this subject is hardly appropriate. Initially, primary and early secondary osteoplasties became very popular, thereafter late secondary or tertiary osteoplasty found general favour. At present a clear trend exists to operate at a younger age again: secondary osteoplasty being performed at 6-12 years of age. However, in a number of cleft centres primary osteoplasty remains in favour. The overall results of the different procedures appears to continue to improve, though the ideal solutions are still not exactly known, nor generally agreed upon. For the time being, a good overall result should be obtained in more than 80% of cases, complete failures should not be seen in more than 5% of a series. Autogenous bone appears to be by far the best graft material. Disagreement exists on the viability of autogenous bone from different donor sites. Periodontal criteria and parameters are used more frequently in a number of recent publications for assessment of the results of the different procedures. Osteoplasty has a relatively high chance of success, especially in the younger age groups. In most institutions, however, too early an age at operation is considered to cause disturbance in growth and development of the middle third of the face. Nevertheless, in this respect operative technique and/or orthodontic treatment seem to play an important role.