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Introduction: Bony reconstruction of the alveolar process and its adjacent platform largely represents the final step in surgical achievement of functionality and aesthetics in cleft patients. Throughout the years, the success of this procedure has been investigated. The aim of this study was to assess the success rate of autogenous mid-secondary alveolar bone grafting in this setting. Methods and Material: A retrospective cohort study was performed. All cleft patients receiving secondary alveolar bone grafts between 1990 and 2020 were reviewed. Criteria for assessing success were long-term preservation of alveolar bone stock, ability of spontaneous or orthodontic-guided eruption and periodontal health of permanent lateral incisors and canine teeth, absence of exposed root structures of neighbouring teeth, absence of fistula and successful placement of implants. Failure of alveolar bone grafts was indicated by radiographically demonstrable total or near-total graft loss requiring reintervention. Results: A number of 124 patients were included and grouped as those primarily operated following our (two-staged palatoplasty) protocol and those receiving cheilorhinoplasty and palatoplasty (one-staged) at other centres. Given the limited cohort size, no complex statistical analysis was performed. In the first group of 64 patients 12 experienced complications (Veau III, eight/36; Veau IV, four/18). In the second group of 60 patients, 12 experienced complications (Veau III, six/37; Veau IV, six/17). Discussion: Our surgical protocol using anterior iliac bone grafts for secondary alveolar reconstruction achieved good results, comparing favourably with previous literature.

Background Enabling intelligible speech plays an important role in achieving social inclusion and a good quality of life of cleft patients. A crude measure of primary palatal repair quality is the incidence of operations to correct velopharyngeal insufficiency (VPI) after speech-language therapy has proven inadequate. This study assessed the necessity for surgery to correct velopharyngeal insufficiency following our standardized two-staged protocol, compared the results with the literature, and identified factors that may influence velopharyngeal competence. Methods A review of the literature was performed. The outcome measure in our series was the necessity for a secondary procedure to correct velopharyngeal insufficiency. The results of literature review were compared with the results of our case series, which we treated using a standardized protocol. Results In our retrospective study, 5 patients (2.5%) required secondary pharyngoplasty. In literature, the frequency of surgery to correct velopharyngeal insufficiency after one- and two-stage protocols were 13.6% and 24.5%, respectively. No statistical difference was found between bilateral and unilateral clefts. The frequencies of velopharyngeal surgery were 7.2% after Furlow palatoplasty, 17.5% after a 2-flap palatoplasty, 18.6% after a Wardill-Killner palatoplasty, and 35.6% after a Von Langenbeck palatoplasty. Conclusion The literature reported that one-stage palatoplasty is correlated with a lower incidence of secondary pharyngeal surgery. Our standardized two-stage protocol proved successful in avoiding secondary velopharyngeal surgery but due to the reduced number of patients included in our study, more research is needed., Highlights • A crude measure of primary palatal repair quality is the incidence of pharyngoplasty. • Following our standardized two-stage protocol, 2.9% patients required secondary pharyngoplasty. • In literature, the frequency of pharyngeal surgery after one-stage protocol was 13.6%. • In literature, the frequency of pharyngeal surgery after a two-stage protocol was 24.5%.

Study Design: Technical note. Objective: Computer-aided design and computer-aided manufacturing (CADCAM) is commonly used in craniomaxillofacial (CMF) surgery because of its advantage in customizing medical devices. We used this technology to create individualized, resin-bonded 3-dimensionally printed titanium arch bars. Method: This article describes a patient specific, three-dimensionally (3D) printed, resin-bonded arch bar as an alternative to the classical intermaxillary fixation systems. Results: The ease of application and removal, as well as the protection of the periodontal and cheek tissues, and operator fingers, made this a comfortable technique for both the patient and practitioner. Conclusions: A patient-specific 3D-printed titanium arch bar can be useful in the arsenal of the maxillofacial surgeon.