Alveolar cleft reconstruction with vomerine bone: two surgical procedures in one step: a case series

Aim: Iliac crest (IC) is the most common source of bone for alveolar cleft repair, as it allows for harvesting a large amount of cancellous bone with a high rate of favorable outcomes. Its drawback is the donor-site morbidity. We propose a new technique for alveolar cleft grafting using vomerine bone (VB), which, through bone grafting, reconstructs the alveolus with the VB and simultaneously corrects the nasal septum deviation. Method: We performed 18 alveolar reconstructions with VB in patients with a small bony defect and septal deviation, which would benefit from septoplasty. A matched control group with IC bone grafting was selected. Panoramic X-rays were used for vertical assessment of ossification with the Bergland scale and CT scans for the evaluation of the thickness of the grafted area in the VB and IC groups and compared with an independent samples T-test. A paired T-test compared angular measurements of the septal deviation pre- and post- vomerine grafting. Results: All grafts healed uneventfully, with no complications at the donor site and respiratory function was improved. There was no statistically significant difference in ossification height between VB and IC, the alveolar thickness at the occlusal and middle third was higher with IC. Septal deviation was reduced significantly. Conclusion: Alveolar graft from VB seems to be a viable alternative to IC in patients who present with a mild bony alveolar defect in addition to septal deviation, allowing combined procedures while reducing the morbidity of the donor site.