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Objective: The aim of this study was to compare microcirculatory parameters in normal versus alveolar cleft gingiva in children selected for secondary bone grafting procedures. Study Design: This study included 11 consecutive patients with complete unilateral alveolar clefts who required secondary bone grafting procedures. In a split-mouth design, noninvasive real-time simultaneous measurements among tissue oxygen saturation (StO2), hemoglobin level (rHb), and blood flow parameters were obtained from normal and alveolar cleft gingiva using spectrophotometry and laser Doppler flowmetry. Subsequent noninvasive capillary density measurements and tissue microangioarchitecture were assessed using sidestream dark-field imaging. Results: There were no significant differences in StO2 and rHb between normal and alveolar cleft gingiva. Blood flow, blood flow velocity, and capillary density were significantly decreased in alveolar cleft gingiva (P < 0.05). Conclusions: Alveolar cleft reconstructions alter gingival microperfusion properties, and microvascular changes adapt to conserve peak oxygen saturation. [Copyright &y& Elsevier]