1. Frederick Mars Untalan MD http://entmdclinic.blogspot.com/

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6. 400 % 300 % > 500,000 bone graft procedures / year http://entmdclinic.blogspot.com/

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29. COMPARISON OF GRAFT SOURCES http://entmdclinic.blogspot.com/ site advantage disadvantage consideration ilium large quantity cancellous bone; two teams mild transient gait disturbance all clefts, particularly large & bilateral clefts calvaria minimal posoperative discomfort; incision hidden; low morbidity limited cancellous/diploic bone; increased operative time unilateral clefts; lower success mandibular symphysis same operative field; rapid procurement; minimal pain limited bone older children with small defects rib two teams poor source cancellous bone; postoperative pain; visible scar; risk of pneumothorax not recommended except for primary grafting proximal tibia abundant cancellous bone; easy procedure; mild postoperative pain; two teams - not recommended in patients that have not completed growth

30. COMPARISON OF GRAFT SOURCES http://entmdclinic.blogspot.com/ site advantage disadvantage consideration ilium large quantity cancellous bone; two teams mild transient gait disturbance all clefts, particularly large & bilateral clefts calvaria minimal posoperative discomfort; incision hidden; low morbidity limited cancellous/diploic bone; increased operative time unilateral clefts; lower success mandibular symphysis same operative field; rapid procurement; minimal pain limited bone older children with small defects rib two teams poor source cancellous bone; postoperative pain; visible scar; risk of pneumothorax not recommended except for primary grafting proximal tibia abundant cancellous bone; easy procedure; mild postoperative pain; two teams - not recommended in patients that have not completed growth

31. COMPARISON OF GRAFT SOURCES http://entmdclinic.blogspot.com/ site advantage disadvantage consideration ilium large quantity cancellous bone; two teams mild transient gait disturbance all clefts, particularly large & bilateral clefts calvaria minimal posoperative discomfort; incision hidden; low morbidity limited cancellous/diploic bone; increased operative time unilateral clefts; lower success mandibular symphysis same operative field; rapid procurement; minimal pain limited bone older children with small defects rib two teams poor source cancellous bone; postoperative pain; visible scar; risk of pneumothorax not recommended except for primary grafting proximal tibia abundant cancellous bone; easy procedure; mild postoperative pain; two teams - not recommended in patients that have not completed growth

32. COMPARISON OF GRAFT SOURCES http://entmdclinic.blogspot.com/ site advantage disadvantage consideration ilium large quantity cancellous bone; two teams mild transient gait disturbance all clefts, particularly large & bilateral clefts calvaria minimal posoperative discomfort; incision hidden; low morbidity limited cancellous/diploic bone; increased operative time unilateral clefts; lower success mandibular symphysis same operative field; rapid procurement; minimal pain limited bone older children with small defects rib two teams poor source cancellous bone; postoperative pain; visible scar; risk of pneumothorax not recommended except for primary grafting proximal tibia abundant cancellous bone; easy procedure; mild postoperative pain; two teams - not recommended in patients that have not completed growth

33. COMPARISON OF GRAFT SOURCES http://entmdclinic.blogspot.com/ site advantage disadvantage consideration ilium large quantity cancellous bone; two teams mild transient gait disturbance all clefts, particularly large & bilateral clefts calvaria minimal posoperative discomfort; incision hidden; low morbidity limited cancellous/diploic bone; increased operative time unilateral clefts; lower success mandibular symphysis same operative field; rapid procurement; minimal pain limited bone older children with small defects rib two teams poor source cancellous bone; postoperative pain; visible scar; risk of pneumothorax not recommended except for primary grafting proximal tibia abundant cancellous bone; easy procedure; mild postoperative pain; two teams - not recommended in patients that have not completed growth

34. COMPARISON OF GRAFT SOURCES http://entmdclinic.blogspot.com/ site advantage disadvantage consideration ilium large quantity cancellous bone; two teams mild transient gait disturbance all clefts, particularly large & bilateral clefts calvaria minimal posoperative discomfort; incision hidden; low morbidity limited cancellous/diploic bone; increased operative time unilateral clefts; lower success mandibular symphysis same operative field; rapid procurement; minimal pain limited bone older children with small defects rib two teams poor source cancellous bone; postoperative pain; visible scar; risk of pneumothorax not recommended except for primary grafting proximal tibia abundant cancellous bone; easy procedure; mild postoperative pain; two teams - not recommended in patients that have not completed growth

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45. Incision and flap design for unilateral cleft defect repair Sulcular incision are used to develop sliding flaps Hall HD, Posnick JC. Early results of secondary bone grafts in 106 alveolar clefts. J Oral Maxillofac Surg 1983;41:289–94. http://entmdclinic.blogspot.com/

46. Elevation of labial and buccal mucoperiosteal flaps Creation of labial and palatal flaps after excision of intradefect fistula http://entmdclinic.blogspot.com/

47. Buccal flap elevated superiorly Palatal flaps elevated and pushed posteriorly Palatal flaps are developed sharply with scissors. This also separates the nasal mucosa from the palatal tissue. http://entmdclinic.blogspot.com/

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49. Closure of nasal floor mucosa superiorly ( NF ) and palatal mucosa ( PM ) posteriorly NF PM Palatal closure .This can be done before or after the nasal mucosa is closed http://entmdclinic.blogspot.com/

50. Nasal mucosal flaps are reflected from the bony walls of the cleft. Nasal flaps are approximated with sutures burying the knots when possible http://entmdclinic.blogspot.com/

51. Bone is packed into the defect with a periosteal elevator or orthodontic band pusher. Digital pressure against the palatal flap facilitates packing and protects the palatal closure Placement of particulate cancellous bone into defect http://entmdclinic.blogspot.com/

52. The labial flaps are advanced toward each other and closed. This provides attached keratinized tissue. Exposed areas distally where the flaps have been advanced are left to granulate http://entmdclinic.blogspot.com/

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54. Labial pedicled “finger” flap elevated to cover bone graft as alternative to sliding buccal mucoperiosteal flap http://entmdclinic.blogspot.com/

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58. Frederick Mars Untalan MD http://entmdclinic.blogspot.com/