Chirurgia plastica delle schisi del processo alveolare: La scuola di Bologna

Alveolar cleft repair is a debate topic in Cleft Lip and Palate treatment. Many surgical techniques have been described in the past, but there are different opinions on witch therapy is the best one for this malformation. There are different opinions also on with material is the best for grafting. The repair can be achieve by inserting different material in the cleft or without any grafting, as in the periostioplasty technique so said "boneless bone graft". The material can be autologous, allogenical or alloplastical. Also operative times are a debate topic and the discussion is not focus on of a few days or months of difference, but regard many years. In fact some authors treat alveolar cleft at neonatal age but some others prefer to operate at the age of 8-10 years. The article analyze the evolution in the treatment of this pathology in the last 50 years and to expose the methodology of the School of Bologna. During the period between 1981 and 2006, 460 patients with alveolar clefts have been treated in our unit with autologous bone grafting. Our protocol is to repair alveolar cleft with an autologous bone graft at an average age of 10. The operation is carried out after the growth of maxillary bone is completed for 80%, before the eruption of canine teeth. Autologous bone was taken in the 45% of patients from the skull, 35% from the iliac crest, and the 20% from the chin. The surgical technique of realizing a pocket to home the bone graft, key point to get a good result, and the surgical technique to get bone graft from the donor sites are described. We analyzed the experience of the School of Bologna, we describe the methodology and we evaluated the results and we can conclude that our method let us achieve satisfactory results.