Effect of Alveolar Bone Graft Surgery Timing on Maxillary Size and Position in Non-syndromic Unilateral Cleft Lip and Palate

Abstract

Background:Unilateral cleft lip and/or palate (UCLP) is a congenital condition resulting from incomplete or lack of fusion between orofacial tissues and leads to both functional and aesthetic concerns. Surgical reconstruction of the cleft involves the following procedures: Lip closure, primary palate closure, lip and palate revisions as needed, and alveolar bone grafting (ABG). This study aims to describe the maxillary growth of patients with UCLP, quantify the effect that ABG timing has on maxillary size, and determine the total surgical impact patients with UCLP patients undergo. Materials and Methods: 124 patients with UCLP who received ABG from Seattle Children’s Hospital were evaluated in this retrospective study. Electronic health records were reviewed to assess patient demographic data, time of ABG, cephalometric values before and after ABG, and surgical details, including quantity of surgeries each patient received. T tests were used to quantify maxillary growth compared to age adjusted norms. Logistic regression analysis and ANOVA were used to assess any associations on maxillary growth based on timing of ABG and number of surgeries received. Results: The mean (SD) age of ABG was 9.3 (1.3) years. The mean (SD) growth period evaluated was 8.3 (2.7) years. The average (SD) age of T1 was 7.6 (1.3) years, and T2 was 15.8 (2.6) years (Table 3). All cephalometric measurements of patients were statistically smaller compared to respective age adjusted normal measurements. Patients in this sample had significantly less growth compared to age adjusted norms. Chronologic age and canine development at time of ABG had no significant association with cephalometric changes measured. No association was observed between total number of surgeries and any of the cephalometric measurements. Conclusion: Early ABG for improved outcomes can be performed without significant concern for maxillary growth and development. Palatal revision surgeries needed to improve patients’ function and quality of life should not be postponed due to concerns about maxillary growth.