A 2-Stage Approach to Alveolar Cleft Repair with Combined Cortical and Cancellous Bone Grafting.

BACKGROUND

Achieving optimal efficacy in secondary alveolar bone grafting (SABG) poses a considerable challenge for patients with alveolar clefts after canine eruption. This study introduces a novel technique called the "2-stage SABG" to improve the treatment outcomes for patients who have missed the optimal timing for bone grafting.

METHODS

Patients aged 12 years and older, presenting with unilateral, complete alveolar clefts after canine eruption, were divided into 2 cohorts: conventional and 2-stage groups. The 2-stage group underwent oronasal fistula closure and mucoperiosteal sealing during the initial stage, followed by particulate cancellous bone marrow and mandibular cortical bone grafting in the second stage after a 3-month interval. Six months after surgery, the SABG was evaluated quantitatively and qualitatively using computed tomography.

RESULTS

A total of 81 patients (median age, 14 years; 49 men and 32 women) were included in the conventional group, and the 2-stage group consisted of 33 patients (median age, 19 years; 20 men and 13 women). The 2-stage group exhibited significantly superior outcomes (P < 0.01) in terms of radiographic healing rate (>4 points) (96.97% versus 55.56%), bone bridge height (12.17 mm; interquartile range [IQR], 4.26 mm), bone bridge width (9.09 mm; IQR, 2.74 mm), bone formation rate (69.73%; IQR, 22.73%), and bone resorption rate (48.85%; IQR, 22.57%). In addition, the average 3-dimensional deviations were greater than 3.5 mm at the affected piriform aperture margin.

CONCLUSION

The novel 2-stage SABG approach demonstrates significant benefits in the repair of alveolar clefts and pyriform foramen deformities through combined cortical and cancellous bone grafting.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.