Alveolar Bone Grafting: Donor Site Review of 100 Consecutive Cases in Cleft Lip and Palate

Amin, Kavit; Khor, Wee Sim; Rosich-Medina, Anais; Beale, Victoria

doi:10.1597/15-180

Cited by 24 publications

(11 citation statements)

References 20 publications

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“…Previous studies have shown the added benefits of grafting at a younger age, including a quicker recovery, less morbidity, quicker surgical procedure, and shorter hospitalization. 3,18 These findings are supported by our study, in which all 79 patients were discharged on the first postoperative day, the documented complication rate was 6.3%, the success rate based on the modified assessment tool was 94.9%, and the regraft rate was 0%.…”

Section: Discussionsupporting

confidence: 69%

Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Anver

Mirzai

Powell

et al. 2020

Journal of Oral and Maxillofacial Surgery

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This study used cone-beam computed tomography (CBCT) analysis to assess the long-term radiographic outcomes of early secondary alveolar bone grafting.Patients and Methods: The most recent postoperative CBCT scans of 79 alveolar cleft patients who underwent anterior iliac crest bone grafting by a single surgeon over a 6-year period and met all inclusion criteria were analyzed using a modified assessment tool. Clefts were measured vertically, horizontally, and superiorly in terms of nasal support and then assigned corresponding scores of 0 to 4 to help determine radiographic success. The sites were deemed poor (score of 0 or 1), acceptable (score $ 2), or favorable (score $ 3). Similarly, overall clefts (vertical plus horizontal scores) were classified as poor (score of 0 to 3), acceptable (score $ 4), or favorable (score $ 5). Statistical analysis was used to characterize patient demographic characteristics, to perform subgroup comparisons, and to identify factors specifically predictive of favorable outcomes.Results: The study included 79 patients with a total of 105 clefts. Male patients comprised 60.8% of patients, and 32.9% of patients had a bilateral cleft. The average age at the time of surgery was 8 years 0 months, and the average time until the most recent postoperative CBCT scan was 2 years 8 months. The average scores were as follows: vertical, 2.9 (maximum score possible, 4); horizontal, 3.1 (maximum score possible, 4); nasal support, 2.7 (maximum score possible, 4); and overall cleft, 6.0 (maximum score possible, 8). All 79 patients were discharged on postoperative day 1, and the regraft rate was 0%. Multivariate analysis showed that younger patients had a significantly higher chance of achieving favorable results in terms of vertical scores (P = .0081) and overall cleft scores (P = .0204). The association between younger age and horizontal scores was marginally significant (P = .0667), but no significant association was found between age and nasal support.Conclusions: Younger patients have improved long-term radiographic success with grafted alveolar clefts. This finding supports performing anterior iliac crest bone grafting at a younger age in cleft lip patients.

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Section: Discussionsupporting

confidence: 69%

Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Anver

Mirzai

Powell

et al. 2020

Journal of Oral and Maxillofacial Surgery

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“…A recent study on infants undergoing palatoplasty by Peirson et al (2017) found equivalent outcomes and analgesia in patients who received acetaminophen and ibuprofen alone versus acetaminophen and hydrocodone. Furthermore, Amin et al (2017) reviewed donor site complications following ABG and found that pain was adequately controlled with paracetamol and ibuprofen, with only 14% of their patients requiring oral morphine.…”

Section: Resultsmentioning

confidence: 99%

Dexmedetomidine Decreases Postoperative Pain and Narcotic Use in Children Undergoing Alveolar Bone Graft Surgery

Lopez

Zech

Linton

et al. 2018

The Cleft Palate Craniofacial Journal

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Dexmedetomidine provided superior pain control after surgery and at the time of discharge, as well as a significant decrease in the use of oral narcotics. In our institution, it has since replaced the PCA as a postoperative pain control modality. Absent the risk for respiratory depression, dexmedetomidine has demonstrated a safe option for postoperative pain control in our focused group of pediatric patients.

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“…Although we did not examine aspects such as surgical morbidity, previous retrospective evaluation of 100 SABGs performed by the same cleft surgeon found a low complication rate for this procedure, with 92% of patients being discharged the following day. 16 This evaluation covered a substantial proportion of the operations for which the radiographic outcomes are reported here.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with BCLP underwent simultaneous grafting of both cleft sites. The local surgical protocol for iliac bone harvest and subsequent grafting has previously been described 16 …”

Section: Methodsmentioning

confidence: 99%

Radiographic outcome of secondary alveolar bone grafting in patients with alveolar clefts

Stonehouse-Smith

Beale

Bellardie

2021

Orthod Craniofacial Res

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Objective To determine the outcome of secondary alveolar bone grafting (SABG) in a series of consecutive patients with clefts involving the alveolus. Design and Setting Retrospective cohort study of consecutive operations performed between June 2011 and September 2016 by a single surgeon at a single United Kingdom cleft center. Participants A total of 160 patients with a cleft/s involving the alveolus, inclusive of syndromic patients and those with atypical facial clefts. Interventions A standard protocol involved an oral hygiene program, pre‐surgical orthodontics where necessary and autologous bone grafting from the iliac crest. Main Outcome Measure(s) The Kindelan bone‐fill index was used to evaluate success using occlusal radiographs. Weighted Cohen's kappa coefficient was used as a measure of intra‐ and inter‐rater agreement. Fisher's exact test was used to examine the effects of type of cleft, pre‐surgical orthodontics or age at time of SABG on radiographic outcome. Results There were 200 SABGs assessed. Mean age at time of SABG was 9.1 years old (SD 1.1) with 99% (n = 198) of grafts deemed successful. There were two failures where re‐graft was performed successfully during the study period. A grade 1 outcome was achieved for 92.5% (n = 185) of grafts and this did not appear to be affected by type of cleft (P = .290), pre‐surgical orthodontics (P = .380) or age at time of SABG (P = .081). Conclusions The high success rate reported in this study supports the favorable outcomes of a high‐volume cleft surgeon. These findings can be used for comparative audit with similar units providing cleft care.

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Alveolar Bone Grafting: Donor Site Review of 100 Consecutive Cases in Cleft Lip and Palate

Abstract: The findings suggest that donor site pain may be well controlled with simple, regular analgesia. Children tolerated this procedure well and were safely discharged the day after surgery. Alveolar bone grafting from the iliac crest was found to have low complication rates.

Cited by 24 publications

References 20 publications

Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Dexmedetomidine Decreases Postoperative Pain and Narcotic Use in Children Undergoing Alveolar Bone Graft Surgery

Radiographic outcome of secondary alveolar bone grafting in patients with alveolar clefts

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