Research Information System
ACBİD 19th International Congress, Antalya, Turkey, 8 - 12 April 2026, pp.344, (Summary Text)
Abstract Background: Alveolar cleft repair outcomes are influenced by multiple biological and mechanical factors. In pediatric patients, secondary alveolar bone grafting performed during the mixed dentition period offers significant advantages, including favorable vascularity, minimal scar formation, guidance of canine eruption, and improved bone consolidation. In contrast, adult patients often present with a history of multiple surgeries, resulting in a scarred and fibrotic tissue bed, reduced vascularity, altered anatomy—particularly following procedures such as Le Fort I osteotomy—and difficulty achieving tension-free closure. These factors compromise graft revascularization, increase the risk of oronasal f istula formation, and lead to lower success rates compared to mixed dentition cases. Case Presentation: A 9-year-old pediatric patient with a right unilateral complete cleft underwent secondary alveolar bone grafting during the mixed dentition period. The canine root development was at an optimal stage (less than two-thirds complete), which is critical for timing the procedure. Following oral and nasal mucosal dissection and watertight nasal closure, corticocancellous iliac bone grafting was performed without fixation. Postoperatively, radiographic evaluation demonstrated successful nasal base reconstruction and eruption of the canine through the graft, indicating successful integration. A 36-year-old adult patient with a history of multiple previous surgeries, including Le Fort I osteotomy, presented with a wide and irregular alveolar cleft and an oronasal fistula. After oral and nasal mucosal dissection and watertight nasal closure, a corticocancellous iliac crest bone graft was placed and stabilized with screw fixation. By the second postoperative month, the graft failed to revascularize adequately, became exposed, and was removed. However, at the one-year follow up, complete closure of the oronasal fistula was maintained, representing a significant functional outcome despite graft failure. Conclusion: Successful alveolar cleft repair depends not only on surgical technique but critically on the biological status of the recipient site, particularly its vascularity and degree of scarring. In complex adult cases, achieving stable soft tissue closure and functional improvement may be a more realistic and clinically meaningful goal than aiming solely for complete bony reconstruction. Alternative strategies—such as distraction osteogenesis or staged reconstruction—may also be considered to optimize outcomes. Keywords: Secondary bone grafting, Oronasal fistula, Alveolar cleft repair