Nasal floor suspension in secondary bone grafting in unilateral cleft repair: technical note.

Introduction: One of the most important surgical steps in secondary alveolar bone grafting of the repair of the nasal floor. Proper separation of the nasal and oral mucosa is of utmost importance in order to provide sufficient and adequate space for the bone graft to be placed. A “pocket” is created where the nasal mucosa represents the “roof” and the oral mucosa the “floor”. This pocket will host the bone graft which will regenerate bone in the cleft in order to offer proper bony support for future orthodontic treatment and rehabilitation. Watertight and accurate suture of the nasal mucosa is a decisive step in this surgical technique, so as to avoid prolapse of the nasal floor into the graft space which will hamper bone graft intake. Technical note: We present a technical modification where the nasal mucosa is sutured to the maxillary bone with absorbable sutures to keep the nasal floor in proper suspension and avoid prolapse into the graft. Conclusions: This is a simple technique that helps improve the symmetry of the nasal fossa and maintains the nasal floor in proper tension to avoid prolapse of soft tissue within the graft, enhancing bone formation. It is important to use this technique alongside with a membrane.