Fig 6 - uploaded by C. Carrie Liu
Content may be subject to copyright.
Infant shown weeks after cleft lip repair with nasal conformers made of soft silicone secured in the nostrils. The optimal length of stenting the nostrils after primary rhinoplasty has not been estab- lished, but the senior author (TT) prefers 6 weeks. 

Infant shown weeks after cleft lip repair with nasal conformers made of soft silicone secured in the nostrils. The optimal length of stenting the nostrils after primary rhinoplasty has not been estab- lished, but the senior author (TT) prefers 6 weeks. 

Context in source publication

Context 1
... (Levels IV and V evidence). Evidence supporting the use of PSIO is conflicting. This can likely be attributed to sparse evidence to definitively suggest a presurgical method is superior to another. Existing studies fail to use consistent outcome measures, which have partially driven the development of Eurocleft and Americleft research groups. 26 Two systematic reviews that examine the utility of PSIOs concluded that there is insufficient evidence to suggest an improvement in maxillary arch form/facial growth/occlusion, motherhood satisfaction, infant feeding/nutritional status, or speech 27,28 (Level II evidence). Nasoalveolar molding (NAM) is a type of PSIO that incorporates the intraoral appliance with nostril prongs to improve the cleft nasal deformity ( Fig. 5 ). There is more supportive evidence for PSIO due to the beginning of intraoral devices decades before NAM. Studies have shown that when instituted at 1 week of age and continued for 3 to 4 months, NAM is effective in approximating the cleft as well as improving the nasal deformity. Specifically, patients undergoing NAM treatment experienced improved nasal alar symmetry, columella lengthening, and nasal tip projection 29–32 (Levels II to V evidence). The counter arguments include nasal relapse and maxillary growth constriction. A recent review concluded that there is some evidence for its use in the unilateral cleft population in improving nasal symmetry 33 (Level III evidence). Although randomized controlled trials at multi-institutional levels are lacking, there is evidence that NAM should be incorporated into the routine management of both unilateral and bilateral clefts. In a phone survey that contacted 89% of North American cleft centers, more than one-third of the centers offer NAM as an adjunct to surgical repair of unilateral and bilateral cleft lip. 3,34 Lip adhesion surgery can be performed in unilateral and bilateral cleft lip. It is performed before definitive surgery, typically before 3 months of age. The rationale is that it applies orthopedic pressure on the underlying maxilla, thereby narrowing the cleft for the definitive repair 35,36 (Level V evidence); however, the evidence is limited and there is the potential disadvantage of additional scarring 37 (Level IV evidence). Primary alveolar bone grafting is typically performed at approximately 8 to 10 years of age. Some centers graft the alveolar cleft at age of 5 to 7 years, before the eruption of the permanent ca- nines so as to improve bone height, dentofacial esthetics, and function 38 (Level IV evidence). Performing a primary graft in children younger than this is associated with the risk of insufficient alveolar bone volume. Bone grafting in older children may be associated with an increased risk of failure, as healing occurs more slowly and there is increased donor site morbidity 39 (Level II evidence). Iliac crest cancellous bone harvest is the standard, but other donor sites and off-label use of bone- morphogenetic protein have been described. More rarely described is the use of a split-rib technique with minimal maxillary dissection used for primary alveolar bone grafting, but the risks of maxillary growth restriction if performed too early must be considered 40 (Level IV evidence). A paradigm shift to include primary rhinoplasty at the time of cleft lip repair has been noted over the past few decades 41 (Level V evidence). Given the complexity of the nasal deformities associated with cleft lip, definitive rhinoplasty has and still is typically deferred until after adolescence and full skeletal growth 42 (Level V evidence). The rationale for minimal primary rhinoplasty during infancy was concern that significant change would occur during adolescent growth, necessitating repeat surgery. 43 There was also the theoretic risk of excessive scar tissue that would interfere with nasal growth. Finally, patients with cleft lip often require orthognathic surgery, which should pre- cede definitive rhinoplasty. Arguments against delaying rhinoplasty until adolescence are that waiting may lead to a wors- ened nasal deformity as well as symptoms of nasal obstruction and increased rates of revision surgery 44 (Level IV evidence). It also may be associated with psychological stress, given that patients will have to live with the unrepaired deformity until adolescence. 40 Over the past 3 decades, various investigators have published on their experiences with primary cleft rhinoplasty, demonstrating that stable long-term results can be achieved with minimal growth disturbance 45–53 (Level III–IV evidence). Therefore, some evidence does exist to support primary rhinoplasty in improving nasal appearance and function. A recent study showed that more than half of North American cleft surgeons do perform a limited rhinoplasty at the time of primary lip repair. 3 Nasal stents have been used for the goal of pre- venting secondary deformities with healing and scarring following primary repair ( Fig. 6 ). 54 There have been case series, as well as one prospective study, demonstrating improved alar symmetry in those who underwent postoperative internal nostril stenting 54–56 (Level IV evidence). The limitations of using nasal stents include poor patient tolerance, possible airway distress in the case of stent dislodgement, and pressure ulcers. 55 Currently, there are no randomized controlled trials exam- ining the benefits of postoperative nasal stenting. There is significant variation among studies in measuring and reporting outcomes after cleft lip repair. 57 Some investigators have used clinical pho- tographs with subjective scoring, whereas others use 3-dimensional imaging or anthropometry. The heterogeneity among patient populations, surgical techniques, and outcome assessment strategies make comparisons across studies difficult. One outcome measure that can be used to gauge the success of cleft lip repairs is the rate of revision surgery. In a review of 50 consecutive patients with bilateral cleft lip with either a cleft palate or cleft alveolus, Mulliken and colleagues 58 found a nasolabial revision rate of 33% in the cleft lip and palate group (Level IV evidence). In the cleft lip and alveolus group, the revision rate was 12.5%. In a review of 750 patients with unilateral cleft lip, secondary reconstruction was performed in approximately 35% of patients 37 (Level IV evidence). The highest revision rates were reported by the Eurocleft study, which assessed the practice patterns and outcomes of 5 cleft centers in Northern Europe 59 (Level II evidence). Four centers provided revision rate data. One center reported a lip revision rate of 4%, and the remaining reported rates from 63% to 69%. For revision rates specific to nasal reconstruction, Mehrotra and Pradhan 60 reported a second rhinoplasty rate of 10% after primary rhinoplasty at the time of cleft lip repair (Level IV evidence). Although revision rates provide a quantifiable method of gauging outcomes, it must be inter- preted with caution. The decision to undertake revision surgery is family and surgeon- dependent. As such, the undertaking of revision surgery may be as reflective of these preferences as it is of the esthetic and functional outcomes from the primary repair. Furthermore, higher revision rates as an indicator of poorer outcome may not be accurate, as a child undergoing multiple revisions may actually have a final result that is more esthetically and functionally pleasing than a child who does not undergo any revisions. In a recent retrospective review of 3108 cases, Schonmeyr and colleagues 61 reported an overall short-term complication rate of 4.4% (Level IV evidence). In 0.5% of these cases, the complication was severe enough to warrant revision surgery. The most common early postoperative complications were wound dehiscence and/or infection, which were 4.3% in the previously mentioned study. This was consistent with the rates of 2.6% to 4.6% reported by other studies 26,62 (Level IV evidence). Complete clefts and bilateral clefts were both significantly associated with wound dehiscence 61 (Level IV evidence). Other complications included stitch granuloma (0.2%) and pressure necrosis (0.05%). Concern also has been raised regarding cleft lip repair and effects on maxillary growth. There are various hypotheses for how lip repair can lead to maxillary retrusion. Some postulate that pressure from a repaired lip restricts maxillary growth 63,64 (Level V evidence). Maxillary growth restriction theoretically could be greater in complete cleft lip-palate as the maxillary segments would be less able to withstand the restrictive forces 65,66 (Level IV evidence). In a review of 82 patients with unilateral cleft lip, alveolus, and palate, lip repair was found to be associated with maxillary retrusion 67 (Level IV evidence). Those with more severe defects were found to have greater retrusion. In a prospective study of 22 patients with unilateral cleft lip and palate, lip repair was found to cause transverse narrowing of the maxilla without any effects on sagittal growth 68 (Level IV evidence). A cleft deformity can occur in both the primary and secondary palates. Clefts of the primary palate range from an alveolar notch to those that extend through the hard and soft palates. Clefts of the secondary palate range from a bifid uvula to clefts that extend to the incisive foramen. 2 The soft palate consists of 5 muscles that are responsible for velopharyngeal closure, including the musculus uvulae, the palatoglossus, the pala- topharyngeus, the tensor veli palatini, and the levator veli palatini. The levator veli palatini is the primary muscle involved in velopharyngeal closure. Normally, it originates from the Eusta- chian tube and inserts anteromedially onto the tensor aponeurosis, along with the tensor veli palatine. 69 In the cleft palate, the levator muscles insert aberrantly onto the posterior edge of the hard palate. 2 ...

Similar publications

Article
Full-text available
Nonsyndromic cleft lip with or without cleft palate (NSCL/P) is a common congenital deformity worldwide with multifaceted etiology. The interactions of genes and environmental factors may be related to NSCL/P susceptibility. In the present study, we aimed to identify the relationship between ABCA4 (rs481931, rs560426) and MAFB (rs17820943) polymorp...
Article
Full-text available
Introduction: The IRF6 rs2235373 (C/T) is a polymorphism in the intron region that has been associated with non-syndromic cleft lip and palate (NS CLP) among some populations. Polymorphism in introns can also affect the transcription that should be detected through some changes in IRF6 mRNA expression. This study was aimed to evaluate the effects o...
Article
Full-text available
Nasoalveolar molding (NAM) aims to improve nasal symmetry with a nasal stent in cleft lip and palate (CLP) patients. When plates have to be exchanged because of dentoalveolar growth or cleft reduction, the nasal stent has to be mounted onto a new plate. This procedure elongates visiting hours for patients and parents or requires second treatment se...
Article
Full-text available
Background/aim: The aim of this study was to investigate submucous cleft palate (SMCP) patients in order to document the age of diagnosis, cause of referral, symptoms and palate findings, objective evaluation of nasalance and velopharyngeal dysfunction (VPD), and intervention type. Material and methods: The archive of Hacettepe University Clef...
Article
Full-text available
Cleft palate (ICD 10-Q 35.9) with Protruding of premaxilla is common feature in patient with bilateral cleft lip and palate it is due to the under trained growth at anterior nasal septal and vomero-premaxillary suture without lateral continuities. Hippocrates (400BC) AND Galen(150AD) mansion cleft lip, but not cleft palate in their writing, Cleft p...

Citations

... The available literature ranges from expert opinion to multi-year field studies, but not all treatment techniques receive equal consideration, which makes them hard to compare due to the lack of data [12,16]. The current standard in cleft osteoplasty is largely dominated by the manual execution of the surgical steps. ...
Article
Full-text available
Cleft lip and palate belong to the most frequent craniofacial anomalies. Secondary osteoplasty is usually performed between 7 and 11 years with the closure of the osseus defect by autologous bone. Due to widespread occurrence of the defect in conjunction with its social significance due to possible esthetic impairments, the outcome of treatment is of substantial interest. The success of the treatment is determined by the precise rebuilding of the dental arch using autologous bone from the iliac crest. A detailed analysis of retrospective data disclosed a lack of essential and structured information to identify success factors for fast regeneration and specify the treatment. Moreover, according to the current status, no comparable process monitoring is possible during osteoplasty due to the lack of sensory systems. Therefore, a holistic approach was developed to determine the parameters for a successful treatment via the incorporation of patient data, the treatment sequences and sensor data gained by an attachable sensor module into a developed Dental Tech Space (DTS). This approach enables heterogeneous data sets to be linked inside of DTS, archiving and analysis, and is also for future considerations of respective patient-specific treatment plans.
... While genes play a significant role in the development of oral-facial clefts, they are not the unique cause of these congenital deformities [18]. In the literature [19][20][21], the researchers explained that many patients have a complete cleft palate. Other patients have an incomplete cleft palate. ...
Article
Full-text available
Cleft lips and cleft palates are the most common birth defects in newborns. Pre-surgical correction of unilateral and bilateral cleft lips and palates has been the subject of interest of many previous works. This condition has necessitated the evolution of many surgical and non-surgical techniques to mitigate the problem of this deformity in children. In this study, we proposed a new architecture that can be used instead of the conventional pre-surgical treatment. The proposed architecture has mechanical and electronic parts. This architecture was adopted to apply external stress to the cleft bones and cleft edges using an airbag that is located in the mechanical part. The amount of air in the airbag can be controlled by an available control unit in the electronic part. The effect of external stress on the cleft bones and the cleft edges was analyzed by using the finite element analysis (FEA) method. The FEA study aimed to analyze the displacement, amount of tensile and compressive forces, and Von Mises stress distributions on the cleft bones, cleft edges, nasal septum, and superior alveolar part of the maxillary jaw of unilateral and bilateral cleft models during pre-surgical treatment with the novel architecture. The results show that displacement and stress affected the clefts of both models. Displacement had a significant effect of gradually bringing the clefts closer to each other and returning them to the posterior. The analysis also investigated the effects of stress on the cleft bone and cleft edge. It was found from the results that the stresses helped to bring the incisions closer to the most appropriate position for plastic surgeons. The results prove that the positive and negative X-displacements move in the opposite direction, which means that the cleft edges gradually converge toward each other. Moreover, the negative Z-displacement affected the movement of cleft bones and cleft edges from outside to inside and gradually returned them to a suitable position. The findings show that the proposed architecture can be contributed to the pre-surgical treatment of the unilateral and bilateral clefts as an alternative to the traditional method.
... Clefts of the lip, alveolus and palate constitute amongst the most common congenital malformations of the head and neck and the second most common of all congenital malformations in general. (1) It occurs when tissues in the face and mouth do not fuse properly by the 2nd or 3rd month of pregnancy. (2) Cleft lip and palate are a group of congenital anomalies that put emotional, physical and monitory stress over the child and well as the patient's family member. ...
... 2,7 Debido a los mitos y creencias culturales y religiosas, uno de los desafíos que enfrentan los pacientes con LPF son las burlas, el acoso y las miradas por largos periodos de tiempo que reciben a diario. 12,13 Tener una apariencia diferente y sonar de manera distinta al hablar puede producir graves problemas al momento de comunicarse y relacionarse socialmente, provocando de esta manera problemas de interacción, debido a que los pacientes con LFP buscan ser como todos los demás, sin embargo, estos aspectos negativos se pueden mejorar mediante el apoyo de su entorno familiar y personal profesional. 14,15 Para garantizar la viabilidad de este estudio se han realizado coordinaciones, con las autoridades institucionales de la Universidad Católica de Cuenca, con la dirección de la carrera de Odontología, la cátedra de investigación de la misma, y la Clínica Multidisciplinaria de Labio y Paladar Fisurado. ...
Article
Full-text available
Objetivo: conocer la autopercepción de los niños con Labio y Paladar Fisurado de la Clínica Multidisciplinaria de la Universidad Católica de Cuenca. Materiales y métodos: La presente investigación es un estudio descriptivo- transversal. La muestra consistió en 78 pacientes que fueron atendidos en la Clínica Multidisciplinaria de Labio y Paladar Fisurado de la Universidad Católica de Cuenca de ambos sexos. Para la toma de datos se utilizó una encuesta, contando con consentimiento y asentimiento informados. Información que será organizada, analizada y tabulada en una base de datos en Excel Microsoft Office. Resultados: Respecto a la autopercepción de los pacientes con labio y paladar fisurado un 71.8% afirma sentirse conforme con su imagen, sin embargo, a un 80.8% le gustaría cambiar su apariencia de ser posible. En general se recibieron respuestas positivas en este estudio realizado. Conclusión: Un abordaje multidisciplinario para los pacientes con labio y paladar fisurado, ayuda a mejorar la calidad de vida y mejora la autopercepción de cada uno de ellos.
... Comprehensive cleft care has two parts-Non-surgical and Surgical therapy. 16,17,18,19,20,21,22,23,24 (Fig.2) ...
Article
Cleft lip and palate is one of the most common congenital anomalies requiring multidisciplinary care. Such anomaly is associated with many problems such as impaired feeding, defective speech, hearing difficulties, malocclusion, dental abnormalities, gross facial deformity as well severe psychological problems. Cleft of the lip and palate is one of the complex conditions that occur at a functionally potential area in the orofacial region and also at such a crucial time that strategic interventions at the right age by the concerned specialists becomes the need of the hour. Pediatric dentist is an integral part of the cleft rehabilitative process right from the neonatal period upto the phase of permanent dentition. Being well versed with a childs growth and development, both physical and mental, a Pedodontist helps in restoring function and esthetics in a cleft child, in a most empathetic way. This article describes the enormous challenges faced by these innocent souls and the vital role played by a Pedodontist, to provide comprehensive cleft care, be it preventive, restorative, or interventional care, in order to achieve the best possible outcome and meaningfully improve their quality of life.
... Of these, congenital anomalies account for 25.3-38.8 million disability-adjusted life-years worldwide [2,3]. Cleft lip and/or palate (CL/P) is the most common congenital orofacial malformation [4] and disproportionally affects LMICs, with a prevalence two to four times greater than in high income https://doi.org/10.1016/j.ijporl.2020.110026 Received 22 January 2020; Received in revised form 25 March 2020; Accepted 25 March 2020 ...
Introduction Though access to surgical care for cleft lip/palate has expanded in low- and middle-income countries (LMICs), post-palatoplasty speech therapy is often lacking due to limited healthcare infrastructure and personnel. This mixed-methods study seeks to: 1) evaluate the impact of task-shifted speech therapy on a standardized speech score; 2) describe the experiences of families with post-operative cleft care and associated barriers; and 3) understand how to optimize cleft care by exploring the experiences of children who had nominal improvements after task-shifted speech therapy. Methods A convergent parallel mixed-methods study was conducted in Nepal. Standardized speech scores were compared by a blinded speech-language pathologist before and after the speech intervention. Semi-structured interviews (SSIs) and focus groups with families evaluated cleft care experiences and barriers. Qualitative and quantitative data were merged and analyzed. Results Thirty-nine post-palatoplasty children with speech deficits (ages 3-18) underwent task-shifted speech therapy, and demonstrated significant improvements in composite speech scores targeted by exercises (p<0.0001) and weakness (p=0.0002), with improvements in misarticulation (p=0.07) and glottal stop (p=0.05) that trended towards significance. Forty-seven SSIs demonstrated that the greatest barriers to follow-up were family responsibilities (62%), travel/distance (53%), and work (34%). In five focus groups, families expressed a desire to improve their child’s speech and seek formal speech therapy. The speech intervention was found to be beneficial because of the compassionate staff, free lodging/food, and ability to socialize with other cleft patients and families. After merging quantitative and qualitative data, we noted that younger children between 3-5 years old and families who traveled greater distances for healthcare access benefited less from the speech therapy intervention. Conclusions Task-shifted speech therapy has the potential to improve cleft lip/palate speech in LMICs. Multiple biosocial issues limit access to appropriate post-operative care.
... In published case reports of CA, muscle relaxants were suggested to provide airway safety. [12][13][14] There were no signs of difficult intubation in patients with bilateral CA. Three patients were Cormack and Lehane grade 3 after direct laryngoscopy with a Macintosh blade. ...
Article
Full-text available
In this retrospective study, we reviewed the anesthesia management of patients with choanal atresia (CA). Fourteen patients undergoing surgery for CA between June 2007 and September 2018 were evaluated for age, gender, CA side, complications, American Society of Anesthesiologists score, duration of anesthesia, and presence of any additional anomalies. Six patients (42%) had bilateral atresia, and 8 (58%) had unilateral atresia. Various congenital anomalies were present in 50% of patients with bilateral atresia. Three patients were intubated with a C-MAC D pediatric blade because their Cormack-Lehane grade was 3 or 4. Though sevoflurane was used for all patients, total intravenous anesthesia was used for two patients with unilateral atresia. All patients were followed postoperatively while intubated except one patient with bilateral atresia. There was no need for postoperative intubation of any patients with unilateral atresia. In conclusion, clinicians should be aware of perioperative and postoperative complications in patients with CA, bilateral atresia, and accompanying congenital anomalies in the neonatal period. Total intravenous anesthesia can be chosen instead of inhalation anesthesia in appropriate cases, but sevoflurane can be used safely in the induction of anesthesia.
... Clefts of the lip, alveolus and palate are the most common congenital malformations of the head and neck and the second most common of all congenital malformations in general [1]. Both cleft lip and cleft palate (CP) occur when tissues in the face and mouth do not fuse properly by the 2nd or 3rd month of pregnancy. ...
Article
Full-text available
Background Although considerable progress has been made in the last 30 years in the treatment of cleft palate (CP), a multidisciplinary approach combining examinations by a paediatrician, maxillofacial surgeon, otolaryngologist and speech and language pathologist followed by surgical operation is still required. In this work, we performed an observational cross-sectional study to determine whether the CP grade or number of ventilation tubes received was associated with tympanic membrane abnormalities, hearing loss or speech outcomes. Methods Otologic, audiometric, tympanometric and speech evaluations were performed in a cohort of 121 patients (children > 6 years) who underwent an operation for CP at the Vall d’Hebron Hospital, Barcelona from 2000 to 2014. Results The most and least frequent CP types evaluated according to the Veau grade were type III (55.37%) and I (8.26%), respectively. A normal appearance of the membrane was observed in 58% individuals, of whom 55% never underwent ventilation ear tube insertion. No statistically significant associations were identified between the CP type and number of surgeries for insertion of tubes (p = 0.820). The degree of hearing loss (p = 0.616), maximum impedance (p = 0.800) and tympanic membrane abnormalities indicative of chronic otitis media (COM) (p = 0.505) among examined patients revealed no statistically significant association with the grade of CP. However, an association was identified between hypernasality and the grade of CP (p = 0.053), COM (p = 0.000), hearing loss (p = 0.000) and number of inserted ventilation tubes. Conclusion Although the placement of tympanic ventilation tubes has been accompanied by an increased rate of COM, it is still important to assess whether this is a result of the number of ventilation tubes inserted or it is intrinsic to the natural history of middle ear inflammatory disease of such patients. Our results do not support improvements in speech, hearing, or tympanic membrane abnormalities with more aggressive management of COM with tympanostomy tubes.
... Surgical repair is the cornerstone of treatment and should be performed early in life, ideally at the age of 3 to 6 months for cleft lip (CL) and 9 to 12 months for cleft palate (CP; Shaw et al., 2001;Rosenstein et al., 2003;Katzel et al., 2009;Colbert et al., 2015;Sitzman et al., 2015;Massenburg et al., 2016). If left unrepaired, orofacial clefts can result in speech dysfunction, eating impairment, and social stigma (Shaye et al., 2015). It can lead to exclusion from education and work opportunities, substantially affecting the patient, family, and community (Magee et al., 2010). ...
Article
Background: In low- and middle-income countries, poor access to care can result in delayed surgical repair of orofacial clefts leading to poor functional outcomes. Even in Brazil, an upper middle-income country with free comprehensive cleft care, delayed repair of orofacial clefts commonly occurs. This study aims to assess patient-perceived barriers to cleft care at a referral center in São Paulo. Methods: A 29-item questionnaire assessing the barriers to care was administered to 101 consecutive patients (or their guardians) undergoing orofacial cleft surgery in the Plastic Surgery Department in Hospital das Clínicas, in São Paulo, Brazil, between February 2016 and January 2017. Results: A total of 54.4% of patients had their first surgery beyond the recommended time frame of 6 months for a cleft lip or cleft lip and palate and 18 months for a cleft palate. There was a greater proportion of isolated cleft palates in the delayed group (66.7% vs 33.3%). Almost all patients had a timely diagnosis, but delays occurred from diagnosis to repair. The mean number of barriers reported for each patient was 3.8. The most frequently cited barriers related to lack of access to care include (1) lack of hospitals available to perform the surgery (54%) and (2) lack of availability of doctors (51%). Conclusion: Delays from diagnosis to treatment result in patients receiving delayed primary repairs. The commonest patient-perceived barriers are related to a lack of access to cleft care, which may represent a lack of awareness of available services.
... A multitude of clinical problems are associated with cleft patients, including deficient facial growth, malocclusion, and respiratory, feeding, and speech complications [4], requiring a comprehensive and multi-disciplinary approach for their care. Bone graft surgery is an essential step in the comprehensive treatment of cleft patients. ...
Article
Full-text available
A majority of patients with orofacial cleft deformity requires cleft repair through a bone graft. However, elevated amount of bone resorption and subsequent bone graft failure remains a significant clinical challenge. Bisphosphonates (BPs), a class of anti-resorptive drugs, may offer great promise in enhancing the clinical success of bone grafting. In this study, we compared the effects of systemic and local delivery of BPs in an intraoral bone graft model in rats. We randomly divided 34 female 20-week-old Fischer F344 Inbred rats into four groups to repair an intraoral critical-sized defect (CSD): (1) Control: CSD without graft (n = 4); (2) Graft/Saline: bone graft with systemic administration of saline 1 week post-operatively (n = 10); (3) Graft/Systemic: bone graft with systemic administration of zoledronic acid 1 week post-operatively (n = 10); and (4) Graft/Local: bone graft pre-treated with zoledronic acid (n = 10). At 6-weeks post-operatively, microCT volumetric analysis showed a significant increase in bone fraction volume (BV/TV) in the Graft/Systemic (62.99 ±14.31%) and Graft/Local (69.35 ±13.18%) groups compared to the Graft/Saline (39.18±10.18%). Similarly, histological analysis demonstrated a significant increase in bone volume in the Graft/Systemic (78.76 ±18.00%) and Graft/Local (89.95 ±4.93%) groups compared to the Graft/Saline (19.74±18.89%). The local delivery approach resulted in the clinical success of bone grafts, with reduced graft resorption and enhanced osteogenesis and bony integration with defect margins while avoiding the effects of BPs on peripheral osteoclastic function. In addition, local delivery of BPs may be superior to systemic delivery with its ease of procedure as it involves simple soaking of bone graft materials in BP solution prior to graft placement into the defect. This new approach may provide convenient and promising clinical applications towards effectively managing cleft patients.