Morbidity of Patients With Cleft Lip and Palate Treated With Alveolar Bone Grafting at About 6 Years of Age
Alveolar bone grafting (ABG) is required in patients with cleft lip and palate (CLP) to reconstruct the alveolar cleft. Secondary ABG (using autologous iliac crest bone graft) at 9-11 years of age, prior to the eruption of the cleft-adjacent canine, has now been widely accepted. It has also been associated with minimal morbidity1. This approach does not take into consideration the eruption of the cleft-adjacent central and lateral incisors. To optimize the periodontal status of all cleft-adjacent permanent teeth, some cleft centers perform secondary ABG at about 6 years of age, at the time of eruption of the cleft-adjacent maxillary central incisor2. Unfortunately, the morbidity associated with the procedure in this younger patient population has not been extensively studied. The purpose of this study is to retrospectively investigate the morbidity of patients with CLP treated with ABG at about 6 years of age.
Materials and Methods:
A retrospective study of 55 ABG performed in patients with CLP during a 5-year period was conducted at the IWK Health Sciences Center in Halifax, Nova Scotia, Canada. The patients with CLP were subdivided into early (<8 years) or late (≥8 years) secondary ABG. The exclusion criteria included: patients with incomplete records, patients with less than 12 months of follow-up, and patients who received ABG in adulthood. The outcome variables were: length of hospital stay, intraoral postoperative infections, postoperative oronasal fistula, graft failure, and subjective gait disturbance.
Method of Data Analysis:
The t-test test was used to analyse continuous variables. The Pearson Chi-Square test categorical variables
Results:
A total of 44 patients with CLP met the inclusion criteria (33 unilateral CLP, 11 bilateral CLP). The mean ± SD follow-up was 37.4 ± 14.6 months. The ABG was performed early in 39 patients with CLP (mean age ± SD = 6.05 ± 0.60) and late in 5 patients with CLP (mean age ± SD = 10.80 ± 2.95). Patients in the early ABG group spent a mean ± SD of 1.9 ± 0.6 days in the hospital, compared to 1.8 ± 0.4 days in the late ABG group (P=0.622). Intraoral postoperative infections occurred in 5% of patients in the early ABG group (2/39, both bilateral CLP patients), compared to 20% of patients in the late ABG group (1/5; P=0.214). One postoperative oronasal fistula (2.6%; palatal oronasal fistula) and one ABG failure (2.6%; one side of a bilateral ABG) occurred in the early ABG group, compared to no fistula or graft failure in the late ABG group. This difference was not statistically significant (P=0.717). No subjective gait disturbances were reported.
Conclusion:
ABG at about 6 years of age, at the time of eruption of the cleft-adjacent maxillary central incisor, is a reliable method associated with minimal morbidity.
References:
- Baqain ZH, Anabtawi M, Karaky AA, Malkawi Z. Morbidity from anterior iliac crest bone harvesting for secondary alveolar bone grafting: an outcome assessment study. J Oral Maxillofac Surg 2009;67(3):570-5.
- Precious DS. A new reliable method for alveolar bone grafting at about 6 years of age. J Oral Maxillofac Surg 2009;67(10):2045-53.