Primary closure of the cleft alveolus: a functional approach.

The growth and development of the premaxilla in both normal and cleft lip and palate subjects is described and its relevance in surgery of the cleft alveolus discussed. Embryologically, the cleft alveolus results from failure of fusion of the median nasal and maxillary processes. Consequently, ossification centres in the premaxilla and maxilla cannot migrate and unite such that normal growth and development in the territory of the premaxillary-maxillary suture cannot occur. Functional repair of the cleft lip and soft palate encourages spontaneous alignment of the alveolar segments, facilitating the introduction of vascularized periosteum across the bony defect by gingivoperiosteoplasty. Early reconstruction in the region of the premaxillary-maxillary suture encourages a more normal development of the alveolus, particularly in the bilateral cleft subject.