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3D Volumetric Analysis of Alveolar Clefts Using Cone-Beam Computed Tomography

Trent James, BS Kiersten Woodyard De Brito, MPH Nathan Lawera, MD, MS Sydni Meunier, MD Joseph Easton, MD Brian Pan, MD, FACS Scott Rapp, MD, FACS
University of Cincinnati

Presenter: Nathan Lawera

Nathan contributed to this project equally with the other authors.

Director Name: Ann Schwentker

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial

Purpose: Alveolar bone grafting (ABG) is standard management for alveolar defects in cleft lip and palate patients. In this study, we examine the potential use of Cone-Beam Computed Tomography (CBCT) and 3-Dimensional segmentation for volumetric quantification of alveolar clefts.

Methods: A retrospective chart review was performed for patients who underwent ABG from 2018-2022. ITK-Snap neuroimaging software was used in 3-Dimensional segmentation of CBCT imaging, obtaining measurements of volume and widths of alveolar clefts pre- and post-operatively. Anatomic landmarks for 3D segmentation were agreed upon by craniofacial orthodontists and surgeons.

Results: 11 post-operative and 15 pre-operative CBCT studies for patients who underwent ABG were available for 3D segmentation. 10 pre-operative studies were conducted for primary ABG and 5 for revision planning. For post-operative segmentations of successful ABG, original cleft width averaged 5.35mm, cleft residual volume averaged 559.1mm3, and bony bridging height averaged 6.06mm. Original cleft width in patients who required revision was significantly higher compared to those who did not (7.89mm vs. 5.35mm, p=0.025). However, there was not a statistically significant difference between the residual volume of clefts which required revision and those that did not (945.9mm3 vs. 559.1 mm3, p=0.11).

Conclusions: 3D segmentation has potential in pre-operative planning of alveolar bone grafting, utilizing images often already obtained by craniofacial orthodontists. Preliminary results from 3D analysis of CBCT indicate width of cleft may be more influential in ABG success compared to overall cleft volume. Continued investigation will include regression analysis of cleft width and volume corresponding to ABG outcomes.

Ohio,Pennsylvania,West Virginia,Indiana,Kentucky,Pennsylvania American Society of Plastic Surgeons

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