The Use of Periosteum and Surgicel® For Bone Restoration in Congenital Clefts of the Maxilla: A Clinical Report and Experimental Investigation

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Abstract
New principles are introduced for the primary repair of the maxilla in congenital cleft deformities, founded on the assumption that periosteum and bone bordering the cleft possesses normal growth potential. By periosteum to periosteum apposition all around the cleft new bone was formed. In complete clefts continuity between the segments was achieved, the premaxilla became firmly consolidated into the arch, maxillary collapse was prevented, and there was a favourable approximation within the alveolar region. Over denuded bone complete periosteal regeneration took place and appositional growth of the lateral segment was promoted. To obtain a larger volume of bone by periostealplasty it proved necessary to keep the flaps suitably separated. In maintaining the periosteal membranes in the desired position Surgicel® provided a useful scaffolding. Animal experiments demonstrated that this hemostatic material can be safely used for subperiosteal implantation. This procedure will lead to the formation of cancellous bone within the Surgicel-hematoma mass while the fabric itself will be completely absorbed. The clinical application of this principle in complete and incomplete clefts is reported. The results proved to be most satisfactory with an increase in bone formation and further restoration of facial symmetry. The need for maxillary correction in incomplete clefts is emphasized. Finally, the purpose of bony restoration in maxillary clefts and the rationale of achieving this by bone grafting is discussed. Comments are made on the principles of periosteal repair, and the indications for maxillary orthopedics in our present program of treatment are reviewed.

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