Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. www.PRSJournal.com 365e P rimary closure of the alveolar cleft has been described by many authors with many dif- ferent approaches: bone grafts, 1,2 periosteal pedicled faps, 3 free periosteal faps, 4,5 or muco- periosteal faps. 6 Primary gingivoperiosteoplasty was suggested by Millard in 1980 and consisted of a covering of the alveolar cleft with local muco- periosteal faps, per formed together with lip adhe- sion at the age of 3 months. 7 Delaire postponed the alveolar closure at the age of 18 to 24 months, when the closure of the hard palate was also per- formed, 8 thus naming the procedure early sec- ondary gingivoalveoloplasty. Both Millard and Delaire’s protocol applied a presurgical orthope- dic treatment to position the alveolar ridges close to one another. Since 1988, early secondary gingivoalveolo- plasty was introduced in our surgical protocol and performed at 18 to 36 months, during the stage of hard palate repair, whereas lip, nose, and Disclosure: The present study was not supported by any company, institute, or organization that has profit-obtaining purposes. None of the authors has a financial interest in any of the products or devices mentioned in this article. Copyright © 2016 by the American Society of Plastic Surgeons DOI: 10.1097/01.prs.0000475781.60962.f0 Maria Costanza Meazzini, D.M.D., M.M.Sc. Martina Corno, M.D. Giorgio Novelli, M.D. Luca Autelitano, M.D. Chiara Tortora, D.D.S. Davide Elsido, D.D.S. Giovanna Garattini, M.D. Roberto Brusati, M.D. Milan and Monza, Italy Background: The goal of this study was to evaluate with a three-dimensional method the long-term quality of alveolar ossifcation in unilateral cleft lip and palate patients who underwent early secondary gingivoalveoloplasty according to the Milan surgical protocol. Methods: The sample consisted of 63 computed tomographic scans of unilater- al cleft lip and palate patients in permanent dentition. The average age at the time of assessment was 15.7 years. Alveolar thickness, nasoalveolar height, nasal foor ossifcation, and hard palate morphology were evaluated using dental, axial, and coronal cuts on computed tomographic scans and three-dimension- al models. All measurements were normalized and ratios of the affected side versus the nonaffected side were provided. Volume measurements and ratios of each hemimaxilla were added. The presence or absence of the permanent lateral incisor on the cleft side was also recorded. Results: Alveolar thickness and height were ideal or good, respectively, in 89.5 and 91.4 percent of the sample. Insuffcient ossifcation (<25 percent) was found in three patients (5.2 percent), and only one of them (1.7 percent) presented no bone bridging. A statistically signifcant association was detected between the degree of alveolar ossifcation, the type of nasal foor ossifcation, and volume ratio. Conclusions: Early secondary gingivoalveoloplasty seemed to allow an ade- quate ossifcation of both the alveolar and nasal region. Three-dimensional evaluation of the alveolar cleft ossifcation provided further information on alveolar bridging and allowed evaluation of the bone availability for implant placement. (Plast. Reconstr. Surg. 137: 365e, 2016.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. From the University of Milan, Regional Centre for CLP and Craniofacial Anomalies, Department of Cranio-Maxillo- Facial Surgery, San Paolo Hospital; and the Department of Cranio-Maxillo-Facial Surgery, University of Milano- Bicocca. Received for publication April 26, 2015; accepted September 23, 2015. Long-Term Computed Tomographic Evaluation of Alveolar Bone Formation in Patients with Unilateral Cleft Lip and Palate after Early Secondary Gingivoalveoloplasty PEDIATRIC/CRANIOFACIAL