Incidence of complications in secondary alveolar bone grafting of bilateral clefts with premaxillary osteotomy: a retrospective cohort study

Abstract

Objective To evaluate factors affecting incidence of complications after secondary alveolar bone grafting with premaxillary osteotomy (SABG + PO) in children with complete bilateral cleft of lip and palate (BCLP). Materials and methods Data were collected from children with BCLP treated with SABG + PO from 2004 to 2014 at our institute. Preoperative parameters included age, donor site, race, gingival health, bone quality around cleft-related teeth, premaxilla position, graft timing, presence of canines in the cleft, and presence of deciduous teeth around the cleft area. Logistic regression and the chi-squared test were used to assess correlations and the incidence of complications. Results In the 64 patients, a significant correlation was found between complication rate and timing of bone grafting with respect to early versus late SABG + PO (p = 0.041), age > 12 years (p = 0.011; odds ratio (OR) 5.9; 95% confidence interval (CI) 1.49-23.93), malposition of the premaxilla (p = 0.042; OR 3.3; 95% CI 1.04-10.13), and preoperative bone quality around cleft-related teeth (p = 0.005; OR 5.3; 95% CI 1.6-17.2). Conclusions The timing of SABG + PO is essential, as early SABG + PO is associated with fewer complications. A malpositioned premaxilla and poor bone quality around cleft-related teeth are associated with more complications. Therefore, preoperative orthodontic repositioning of the malpositioned premaxilla before SABG + PO should be considered. Clinical relevance Analysis of treatment protocols and complications for BCLP patients underscores that proper timing of SABG + PO and correct premaxilla repositioning help reduce complications.

Extensive Gingivoperiosteoplasty Versus Secondary Alveolar Bone Grafting in Patients With Complete Bilateral Cleft Lip and Palate During the Mixed Dentition Period

“…Alveolar bone grafting in bilateral cases is considered challenging because of unfavorable position of premaxilla, wide clefts, larger graft volumes, and difficult soft tissue closure. The complication rate varies considerably from 10% to 46%, as reviewed in a recent publication 24 . The complication rate of GPP in this study was 20.83% versus 30% in the ABG group.…”

“…The complication rate varies considerably from 10% to 46%, as reviewed in a recent publication. 24 The complication rate of GPP in this study was 20.83% versus 30% in the ABG group. The complication commonly faced by the GPP group was soft tissue dehiscence, whereas ABG group presented with graft extrusion, sequestrum formation, and pus discharge necessitating dressings and additional antibiotic coverage.…”

A novel method for alveolar bone grafting assessment in cleft lip and palate patients: cone-beam computed tomography evaluation

“…Rehabilitation protocol includes secondary alveolar bone grafting (SABG) that is performed when the patient presents with a mixed dentition [4]. The most favorable outcomes present when the lateral incisor or the canine erupts through the transplant and the bone are functionally loaded [5][6][7][8][9]. The purpose of the autogenous bone grafting is closure of the oronasal fistula and anatomical tissue continuity of the alveolar process in the maxilla [10].…”

Outcome after secondary alveolar bone grafting among patients with cleft lip and palate at 16 years of age: a retrospective study

“…Therefore, prolonged antibiotic treatment was administered after the first SABG, in accordance with other authors. 16 However, after SABG in unilateral CLP antibiotics was only administered for 24 hours. The regime of perioperative antibiotic therapy in cleft surgery, is however not conclusive.…”

“…For patients with bilateral clefts, antibiotic treatment continued for seven days after the first SABG in accordance with other authors. 16 All patients were hospitalized for one day postoperatively. Analgesics (paracetamol or non-steroid anti-inflammatory drugs) were prescribed for seven to ten days postoperatively.…”