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Aim: is to evaluate efficacy of platelet rich fibrin (PRF) sandwiching technique associated with hyaluronic acid (HyA) mixed with alloplastic bone graft in closure of recurrent oronasal fistula after previously alveolar cleft grafting. Subjects and Methods: Our study conducted on 24 patients with recurrent unilateral oronasal fistula complaining of oronasal leakage. They were divided into two random equal groups. Group I, alveolar cleft defect was packed with alloplastic bone graft ( osteon II collagen) between two layers of PRF gel. While, in group II, alveolar cleft defect was packed with a mixture of alloplastic bone graft (osteon II collagen) and HyA between the two layers of PRF gel. All patients were observed clinically and radiographically (CBCT) for evaluation after three and six months postoperatively. Results: Our clinical results revealed that, all patients had uneventful wound healing except 4 cases in group I and one case in group II which had wound dehiscence and graft exposure at 1-week postoperatively. The radiographic results by CBCT scans showed a better new bone formation and good osseous union obliterating the oronasal defect.in group II than group I. There was a significant difference between bone density and bone resorption values in both groups at all intervals. Conclusion : Our results demonstrated that PRF sandwiching technique combined with a mixture of alloplastic bone graft and HyA could provide a favorable bony and soft tissue barriers for closure of recurrent oronasal fistula in alveolar cleft patients. INTRODUCTION Repair of cleft alveolus with alveolar bone grafting (ABG) is an essential step in the overall management of a cleft lip and palate patients. Secondary ABG procedure between 9 and 12 years of age has been established as the “golden standard” for alveolar cleft reconstruction (1-3). Because of the treatment at this time allows stabilization of the maxillary arch, closure of the oronasal fistula, normalization of growth at the cleft site, and creation of bony support for eruption of adjacent permanent teeth (4,5) . The occurrence of ABG failure leading to anterior palatal fistula following surgery clearly compromises these goals(6&7).

al-azhar assiut dental journal

Evaluation of Platelet Rich Fibrin Sandwiching technique with mixture of alloplastic bone graft and Hyaluronic Acid in repair of Recurrent Oronasal Fistula