Methods: In our proposed technique of nasoalveolar cleft repair, nasal and oral mucosal flaps are elevated. Once nasal mucosa is sutured, cyanoacrylate is applied to nasalflap. Nose is irrigated to ensure a water-tight closure. Next, corticalstrut from iliac crest or allogeneic sheet is positioned by friction adaptation. Particulate cancellous marrow or BMP allogenic particulate mixture is compacted. Following advancement and flaps suturing, cyanoacrylate is applied to oral closure. We obtain presurgical Conebeam computed tomography (CBCT), which is compared to 6 months post-surgical study with assessment of grayscale Hounsfeld Units (HU).
Discussion: Fistula leads to regurgitation of fluids, causes speech impediment and cicatrization with multiple repairs. Regional tongue, buccal fat and mucosal flaps and modified local advancements have been used to close fistulae. Following palatoplasty, 11–34% fistulae incidence is reported in literature and recurrence is reported at 50% following repair. Boyne & Sands propose use of suturing a gauze pack in place over the palatal incision aspect follow alveolar cleft closure to serve as a barrier. We aim to provide this stable base by the placement of cortical strut, which is well contoured and positioned with friction grip into the floor of the nose following elevation of the nasal mucosa. Cyanoacrylate does not interfere with bone healing, as periosteal vascularity is unaffected. Faster the vascularization of the transplanted graft occurs, survival increases. Parts of cortical dead bony matrix have osteoinductive potency, serving as scaffold helps vascularization from adjacent foci of osteoclastic resorption and periosteum elements. Cyanoacrylates reinforces sutures and prevents unraveling. At 2 week review, residual film is removed.
Summary: Subjective analysis of operative success was favourable using this protocol for flaps with reduced breakdown. But CBCT analysis of volumetric bonefill is variable from 40% to 100% take. Even with good soft tissue closure the bone density is uneven in volume CBCT studies.