Secondary alveolar bone grafting in cleft lip and palate patients is usually done following expansion using fixed orthodontic appliances such as quadhelix or a hyrax type appliance. Does the surgeon need to remove the appliance to do the graft?
could be better to remove the expansion appliance, to allow to the surgeon to perform surgery without any interference
Temporary removal of the appliance would be essential to compete a bone graft. Prior to re-introducing an appliance, I would suggest waiting 6 to 8 weeks to determine the strength of the graft. Then consider having the prosthedontist creating a new appliance to accommodate the alveolar graft.
As previously mentioned by Colleges, the appliance is preferred to be temporarily removed, however the appliance can stay during surgery provided: the appliance is passive and continue to be passive until graft consolidation, and there is no palatal fistula which is planned to be repaired,
With the appliance in situ its technically difficult to close the palatal fistula. Otherwise a passive appliance is generally not a major hindrance.
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