Secondary Bone Grafting of a Cleft Following Reverse Quad-Helix Expansion

Background: Maxillary expansion prior to bone grafting is essential to gain access for surgical manipulation. Differential anterior versus posterior maxillary expansion is preferable for success. Objectives: To retrospectively evaluate maxillary expansion using a reverse quad helix appliance during early mixed dentition in unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) affected patients before iliac crest cancellous bone grafting. Methods: The demographic data and medical records of 98 UCLP and BCLP affected patients were reviewed. All patients were treated according to the same protocol, including use of a reverse quad-helix appliance for differential anterior maxillary expansion of the premaxilla cleft area. Results: Sixty (61.2%) patients were male and 38 (38.8%) were female. UCLP was present in 60 (61.2%) patients and BCLP in 38 (38.8%). The mean age orthodontic expansion took place was 12.02 ± 4.77 years. The mean hospitalization duration for the bone grafting procedure was 5.45 + 1.11 days. The duration of the surgical procedure was 81.90 + 21.43 minutes and 106.18 + 29.07 for UCLP and BCLP, respectively. Seven patients (6.86%) presented with oronasal fistula, considered a postoperative complication due to the spectrum of insufficient bone at the cleft area, sloughing and partial or total resorption of the grafted bone. Surgery was repeated in these cases resulting in successful bone grafting. Conclusion: Presurgical orthodontic expansion of the cleft area using a reverse quad-helix appliance results in a higher rate of surgical manipulation success compared to the success rate reported in the literature.