25-year Follow-up of Primary Tibial Periosteal Graft for Hard Palate Repair in Cleft Lip and Palate: Outcomes, Concerns and Controversies

Abstract

Objective This study evaluates long-term outcomes in adults with Unilateral and Bilateral Cleft Lip and Palate (UCLP/BCLP) treated during the period 1992 to 1995 with tibial periosteal graft in primary repair. Design Retrospective study. Setting Department of Plastic and Maxillofacial Surgery, Children's Hospital Bambino Gesù (Italy). Patients The study included 52 patients with non-syndromic BCLP/UCLP who met the inclusion criteria. Interventions All patients underwent a standardized surgical protocol using a tibial periosteal graft as primary repair of the hard palate. Main Outcome Measure(s) Long-term outcomes on maxillary growth, residual oronasal fistula, and leg length discrepancy. Results About <2% of patients showed oral–nasal communication. Mean value of maxillary depth was 86° ± 4.5°. The lower value for maxillary retrusion was 76.8° in relation to the Frankfurt plane. At the x-ray control, 12.2% of patients showed leg discrepancy with a difference of always <2 cm. Conclusions The rate of maxillary retrusion obtained was the same if compared to other techniques. Tibial periosteal graft reduces the risk of fistula and the need for reintervention after secondary bone graft. The study did not observe negative impacts on leg growth after 25 years.