Surgical procedure
MPM, labial fistula, alveolar cleft
SEPARATION, CREST, SCAR
All surgical procedures were performed under general anesthesia with nasotracheal intubation. Articaine (ARTINIBSA 4% 1:100000®) was injected at first, into each surgical site for hemostasis. The incision at the recipient site started with two vertical elliptical incisions along the cleft margin from the labial side around the labial fistula if present. The labial sulcular incision was completed till two adjacent teeth medial and lateral to the vertical incisions at the area of cleft; then, 2 vertical releasing incisions were performed which extended upwards and backward into the buccal vestibule and finally brought forwards by about 5 mm to give a hockey stick appearance, this allows an easier approximation of the labial flap towards the palatal one without tension after graft placement. After raising full-thickness labial and palatal flaps, exicion of the scar tissue within the bony cleft was achieved. Afterwards, careful dissection of the labial flaps with adequate nasal lining separation and watertight closure of the nasal layer were completed.For both groups, after gaining access to the anterior iliac crest, a trap door technique was used for cancellous bone chips harvesting. Afterwards, the donor site was closed in layers.In the control group, these bone chips were packed directly into the cleft and flap closure followed (Fig. Clinical photographs showing alveolar cleft grafting using conventional bone particles derived from anterior iliac crest (control group)Clinical photographs showing prepared MPM (sticky bone) ready for application within the cleft gap (study group)Clinical photographs showing alveolar cleft grafting using MPM (study group)