Early Versus Late Alveolar Cleft Repair Using Cancellous Iliac Bone Grafts in A developing country

Document Type : Original Article

Authors

1 Department of Plastic Surgery, Nasser Institute Hospital, Ministry of Health, Egypt

2 Department of Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt

3 Department of Plastic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Egypt

10.21608/ijma.2021.53013.1216

Abstract

Background: Orofacial clefts are common congenital malformations, with alveolar cleft as the most common [75%] of all anomalies. Many treatment modalities are available. However, our clinical experience with bone graft modality is not well addressed.   
The aim of the work: To evaluate the effectiveness of early [2 to 12 years; before complete eruption of the cleft canine] versus late [> 12 years; after complete eruption of the cleft canine] cancellous anterior iliac bone grafting for alveolar cleft reconstruction.
Patients and Methods: Twenty-three patients with alveolar clefts who were admitted for alveolar cleft reconstruction surgery were included. They were categorized into early and late secondary grafting groups. All patients inquired about their history. Submitted to full clinical examination, laboratory and radiological examinations. The imaging studies include two-dimensional orthopantomogram for all patients, while 3-D fascial computed tomography and cone-beam computed tomography were done for selected patients. Both intraoperative and postoperative data were collected, any complications were registered and patients followed up regularly up to 6 months.
Results: Both groups were comparable as regarding patient characteristics except younger age in early group, and there was a statistically significant difference between early and late groups regarding cleft side and cleft permanent canine full eruption. Males represented 69.9%. The cleft was on the left side in 56.4%. Seven patients [30.4%] had maternal risk factor [five in early and two in late group]. Blood loss was less than 80 ml in all patients in both groups. All oronasal fistulas were sealed off successfully in all patients [100%] and all had normal healthy gingival contour with vital teeth adjacent to the cleft.  All showed evidence of good bone filling in the alveolar defect after 6 months postoperatively. Only one patient developed hypertrophic scars at each group .
Conclusion: Alveolar cleft reconstruction is preferred to perform autologous cancellous bone grafting harvested from the iliac crest bone to repair the cleft with excellent outcome on short-term follow-up .

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