Maxillary bone transportation in alveolar cleft—transport distraction osteogenesis for treatment of alveolar cleft repair  Masaharu Mitsugi, Osamu Ito, Rafael E. Alcalde  British Journal of Plastic Surgery  Volume 58, Issue 5, Pages 619-625 (July 2005) DOI: 10.1016/j.bjps.2005.02.020 Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 1 Schema of our method. The movement of the bone segment is guided by the orthodontic arch wire. The residual cleft site at the docking site is grafted with regenerated new bone from the distraction gap. British Journal of Plastic Surgery 2005 58, 619-625DOI: (10.1016/j.bjps.2005.02.020) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 2 A vertical intraoral distraction device (Martin, Germany). We use this device without half side of it's plate and fix it horizontally (Fig. 1). British Journal of Plastic Surgery 2005 58, 619-625DOI: (10.1016/j.bjps.2005.02.020) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 3 (A) The soft tissue in the cleft is removed at the docking site. (B) Bone contact at the docking site (X-ray). (C) After removal of new bone graft at the distraction site. (D) The amount of the bone graft is small. (E) Final cleft gap space is narrow and small. (F) Grafted bone in the cleft gap. British Journal of Plastic Surgery 2005 58, 619-625DOI: (10.1016/j.bjps.2005.02.020) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 4 Case 1. A 37-year-old male with a residual alveolar cleft and oronasal fistula. (A) Pre-operative photograph. (B) Pre-operative 3D-CT. (C) The bone segment moved along the curve of the guided wire (X-ray). (D) The base of dental implant in the distraction site and the veneer bone graft from mandible in support of the base. (E) The base of dental implant kept good position (X-ray). (F) After full attachment of dental implants. (G) Final result. Oronasal fistula was repaired with tongue flap. British Journal of Plastic Surgery 2005 58, 619-625DOI: (10.1016/j.bjps.2005.02.020) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 5 Case 2. A 17-year-old male with an alveolar cleft. (A) Pre-distraction X-ray. (B) Post-distraction photograph. (C) Post-distraction X-ray. (D) Regenerated new bone in the distraction site. (E) Harvesting new bone. (F) Nallow final cleft gap. (G) Small bone graft. (H) Regenerated alveolar ridge (X-ray). (I) The base of dental implant could be fixed in the regenerated new bone (photo). (J) The base of dental implant could be fixed in the regenerated new bone (X-ray). (K) Final result. British Journal of Plastic Surgery 2005 58, 619-625DOI: (10.1016/j.bjps.2005.02.020) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 6 This method is a tissue engineering of bone and mucosa, and shifted nasal septum can be repaired simultaneously. British Journal of Plastic Surgery 2005 58, 619-625DOI: (10.1016/j.bjps.2005.02.020) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions