A Second Alveolar Bone Graft in Cleft Palate Prior to Orthognathic Surgery - A Case Report

Abstract

Intro: Ongoing cleft surgery into adult age is uncommon, with most patients completing their treatment course in the form of orthognathic surgery once they reach adult growth levels. A 32-year-old patient was seen as a day surgery for alveolar bone graft top-up from her left iliac crest to fill in an alveolar defect in the upper left anterior sextant, extending the entire length of the hard palate and involving the floor of nose. History: The patient had initially been treated for primary cleft care and provision of orthodontic fixed appliances due to a unilateral left-sided cleft lip and palate and class III malocclusion; however, it had been deemed further treatment would be required to correct her cleft and occlusion. The patient had had a previous ABG from her left tibia; however, a residual defect remained, and an MDT meeting had recommended top-up to the ABG prior to any orthognathic surgery. Treatment: The left iliac crest was selected to avoid potential confusion over appendicectomy scar on the right. A muco-periosteal flap was raised in the UL1,2,3 region palatally and buccally, revealing a through-and-through defect, as well as defect into the floor of nose. A chisel was used to remove defective bone, and the harvested graft inset with primary closure obtained. Conclusion(s): The patient is due for orthognathic surgery in 2025 in the form of a Le Fort I advancement and mandibular setback.Copyright © 2025