Massei Primary Periosteoplasty

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We read with great interest the article by Jabbari et al. entitled “Skoog Primary Periosteoplasty versus Secondary Alveolar Bone Grafting in Unilateral Cleft Lip and Alveolus: Long-Term Effects on Alveolar Bone Formation and Maxillary Growth.”1 In this study, 57 consecutive patients born with unilateral cleft lip and alveolus were studied retrospectively. The authors conclude that primary periosteoplasty did not seem to inhibit long-term maxillary growth but was ineffective as a method of reconstructing the alveolar cleft.
For the correction of the cleft maxilla, we commonly perform periosteoplasty using local periosteal flaps, according to Massei.2 This surgical technique is derived from the one originally proposed by Skoog, modified according to the studies on periosteum from Bernardino Larghi.3
The periosteum of the anterior aspect of the maxilla (Fig. 1) is transferred as an island flap instead of using it as a precarious pedicle flap. Skoog’s flap is just a very thin periosteum flap, not based on blood supply; it is a rotational flap and has an unfavorable ratio between base and length.
The island flap by Massei, transferred as a “subperiosteal lifting” over the cleft (Fig. 2), is based on the cheek tissues lying over the periosteum, thereby including the insertions of the mimic muscles, giving a blood supply that increases the osteogenic activity of the periosteum.2
In our opinion, the bone production in the maxillary cleft is greater using island periosteoplasty, as described by Massei, compared with the Skoog periosteoplasty. In fact, using the Massei periosteoplasty, the production of bone is satisfactory in more than 70 percent of clefts, and does not require a bone graft.2,4 In conclusion, we strongly believe that periosteoplasty as described by Massei helps new bone formation, gives more symmetry to the nasal pyramid, and minimally interferes with maxillary growth.
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