Isolated keratinized gingiva incision in alveolar cleft bone grafts improves qualitative outcomes: a single surgeon's 23 year experience.

BACKGROUND: Few publications have described the flap design of the secondary cleft alveoloplasty. In this article we describe a modified technique of the classical flap design with the purpose of minimizing injury to the dental papillae and periodontium of the involved dentition. We report our long-term experience, specifically with regards to oronasal fistulae recurrence, wound healing and graft exposure and loss.

METHODS: All the patients were operated on using the same technique by a single surgeon. A total of 148 clefts have been operated with this approach, involving 117 patients with complete cleft lip and palate with a follow-up between 12 and 240 months.

RESULTS: The most important finding in this study is the excellent wound healing observed in almost all patients. Only three patients (2%) suffered a dehiscence with oronasal fistulae recurrence and bone loss. Another patient lost the graft without fistula recurrence. Minor dehiscence with partial bone loss occurred in 4 patients (2.7%). These patients did not need surgical closure and only superficial exposed bone particles were lost without compromising the clinical outcome.

CONCLUSIONS: Our modification presents a flap design that is easy to elevate and mobilize, without disturbing the buccal sulcus or the gingival inter-dental papillae.