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Reconstruction of cleft maxilla with periosteoplasty.

The principle of gnatoplasty using local periosteal flaps according to Skoog is employed, but an essential modification in reconstructing the cleft maxilla is suggested. The periosteum of the anterior aspect of the maxilla is transferred as an island flap instead of using it as a precarious pedicle flap. The island flap is based on the cheek tissues lying over the periosteum, thereby including the insertions of the mimic muscles. The vascular supply and the osteogenic activity of the periosteum is preserved, and satisfactory new bone production is obtained.