The use of cranial bone grafts in the closure of alveolar and anterior palatal clefts.

A method is described for harvesting cancellous bone from the diploic space. In our opinion, this is the material of choice for bone grafting alveolar clefts in the 7- to 11-year age group. The procedure could be performed at an earlier age if the maxillary segments are under orthopedic control and in proper alignment. Success of the procedure depends on proper orthodontic preparation of the maxillary segments and careful, complete closure of the soft tissues across the anterior palatal cleft, the nasal lining defect, and the anterior alveolus. Results have been encouraging in terms of bone formation, and tooth migration into the bone graft can be expected if there has been no damage to the dental sac. Closure of the alveolar defect at the time of the primary lip closure would preclude the eventual need for a bone graft, but it cannot be accomplished without early, precise alignment of the maxillary segments if extensive periosteal denudation is to be avoided. The age beyond which periosteal closure alone will be inadequate to provide sufficient bone formation and should be supplemented by a bone graft remains to be established.