Limited Access to Alveolar Bone Graft Surgery Following Primary Cleft Lip and Palate Repair in Indonesia: A Questionnaire-Based Qualitative Study

Abstract

Introduction: Cleft Lip and Palate is the most common craniofacial anomaly, and cleft lip and palate repair is widely performed. Alveolar cleft accompanies 75% of cleft lip cases and requires alveolar bone graft (ABG) surgery at mixed dentition age. However, studies on rates of ABG surgery are scarce. Objective: This study aims to investigate the low popularity of ABG and orthodontic care among patients with ABG history at Cleft and Craniofacial Centre, Cipto Mangunkusumo Hospital, Jakarta. Method: A total of 771 patients had orofacial cleft surgeries throughout 2015 to 2021. A descriptive analysis of labioplasty, palatoplasty, and ABG surgeries was presented. Questionnaire-based qualitative analysis of ABG was obtained from the patient’s guardians to evaluate the limitation and experience of conducting the surgery at our institution. Results: We distributed questionnaires to 13 patients with a history of ABG. ABG accounted for only 5% of total orofacial cleft surgeries. The average age of ABG surgery and orthodontic care initiation was 11 and 11.8 years old, respectively. About 82% had access to preoperative and postoperative orthodontic care; however, only 11% received PSO before 9 years old. The satisfaction rate was 100% and 75% in ABG patients with and without orthodontic care, respectively, reporting improved feeding, speech, teeth alignment, and esthetic result. Conclusion: Orofacial cleft management requires a multistage, comprehensive, and multidisciplinary approach. The number of ABG surgeries is low in developing countries, attributed to unequal access to ABG and orthodontic care, suggesting that limitations of knowledge, geography, and economy play a big role in Indonesian healthcare.

Characterization and functional prediction of the dental plaque microbiome in patients with alveolar clefts

“…As the frontonasal prominence develops, an inadequate union of the maxillary and median nasal processes results in the formation of the alveolar cleft (AC) (Mundra et al, 2022). Approximately 75% of all complete cleft lip and palate (CLP) patients are AC patients who require alveolar bone grafting (ABG) (Bangun et al, 2023;Destrez et al, 2023). AC, which is situated in the region bounded by the lateral incisors and canines, causes pathologic phonation, orofacial fistulas, fluid reflux, overcrowding, maxillary anterior-posterior and transverse defects, absence of bony support for maxillary anterior teeth, and disruption of the continuity of the maxillary arch (Gaillot et al, 2007;Guo et al, 2011;Tamasas and Cox, 2017;Ahmed et al, 2020;Buile et al, 2022).…”