Alveolar Cleft Closure Managed by Primary Alveoloplasty
Classic terminology used to describe the repair of the alveolar cleft is not standardized and can be confusing. The French Cleft Centers proposed that the term 'primary surgery' should be reserved for the initial time of cleft closure, independent of the age of the patient. Consequently, 'secondary surgery' should be used to describe the management of sequelae. Surprisingly, in the literature, most authors currently use the term 'primary alveoloplasty' only when cleft surgery is performed in very young children (younger than 18 months old) Accordingly, 'secondary alveoloplasty' is the term used when surgery is performed in older children, and it is referred to as 'early' secondary alveoloplasty if the surgery is performed on children between 4 and 11 years old and 'late' secondary alveoloplasty if the surgery is performed on children older than 11 years (Delaire et al. 1969; Ronchi et al. 1995; Precious, 2003) Even Brusati and colleagues (1992) who carried out alveoloplasty at the same time as primary palate closure on children between 16 and 36 months old, used the term 'early secondary gingivoperiosteoplasty. This surprising use of the term 'secondary alveoloplasty' first appeared in the 1970s (Boyle and Sands, 1972; Bergland et al. 1986) and was probably used then to differentiate this surgical procedure from primary alveoloplasty with early bone grafting (Schrudde and Stellmach, 1958; Schuchardt and Pfeifer, 1960; Johanson and Ohlsson, 1961; Nylen et al. 1974) which was rapidly abandoned because it led to growth disorders of the maxilla (Jolleys and Robertson, 1972; Berkowitz, 1977; Henkel and Gundlach, 1997) In our opinion, the terms 'primary' and 'secondary' should not be linked to the timing of surgery. Indeed, nobody would use the term 'secondary cheiloplasty' to describe cleft lip surgery performed on a 15 year old patient treated in a developing country, because cleft lip repair is primary surgery. Indeed, primary surgery contrasts with secondary surgery, which deals with sequelae on an already closed region. Thus, primary cheiloplasty describes the repair of cleft lip, primary veloplasty describes the repair of the soft palate, primary uranoplasty describes the repair of the hard palate, and primary alveoloplasty is the repair of an alveolar cleft. By contrast, we propose that the term 'secondary cheilorhinoplasty' should be reserved to describe revisions of cleft lip nose sequelae (for aesthetic and/or functional purposes) and the term 'secondary repair of the soft palate' should be used to describe soft palate surgery for velopharyngeal insufficiency. We therefore propose the following classification for the management of an alveolar cleft. These guidelines can be applied irrespective of the technique used for the repair (e.g. gingivoperiosteoplasty, periosteoplasty as Skoog described it in 1965, Muir flap) and the use of bone grafts or biomaterials. The term 'primary alveoloplasty' should be used for the initial surgical repair of an alveolar cleft, irrespective of the timing of the procedure. This may include the following:
The Cleft palate craniofacial journal official publication of the American Cleft Palate Craniofacial Association