Reply: Alveolar Bone Grafting and Cleft Lip and Palate

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Regarding Liu et al., we agree that watertight closure of the oral mucosa over the bone graft is essential for optimal graft survival. Several methods of optimizing mucosal closure have been suggested, including preoperative deciduous tooth extraction1,2 and decreasing mucosal inflammation through improved oral hygiene.3 The authors believe that the technique described by Liu et al. is in many ways similar to those elucidated in their recent article.4 Internal flaps off the maxilla are incised low in the cleft and used to close the defect in the floor of the nose. External flaps are then used to close the defect in the oral and palatal mucosa.
It is difficult to determine the nature of the two-layer closure in the inferior portion of the defect either from the text or the figure provided by Liu et al. Intraoperative photographs might be helpful in this regard. Furthermore, although Liu et al. report “satisfactory” alveolar bone graft outcomes using their technique, they do not provide the outcome measures used or quantitative data. We look forward to further details about the design, use, and efficacy of the technique described by Liu et al. as they become available.
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