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Simultaneous alveolar fistula repair and bone graft during Lefort I advancement in cleft patients: Improving outcomes and decreasing morbidity using allograft only bone graft
S Alex Rottgers MD, Lino Miele MD, Zoe M MacIsaac MD, Anand R Kumar MD
Division of Pediatric Plastic and Reconstructive Surgery, University of Pittsburgh, Cleft/Craniofaci
2013-03-14
Presenter: S Alex Rottgers MD
Affidavit:
chart reviews, data analysis, and abstract drafting were all completed in part or completely be the resident.
Director Name: Joseph E. Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Purpose: Cleft patients requiring maxillary advancement with persistent alveolar defects after failed prior bone grafting (ABG) present a unique reconstructive challenge. This study aims to demonstrate use of allograft bone alone for fistula repair at the time of Lefort I surgery is safe and efficacious.
Methods: A 30-month retrospective review of patients undergoing Lefort I advancement with simultaneous ABG using demineralized bone matrix with cancellous chips (DBX Mix, Synthes, Inc., West Chester, PA).
Results: Ten patients underwent 11 Lefort 1 advancements with concurrent ABG of 15 alveolar gaps. Seven patients underwent two-piece and three underwent one-piece advancements. An average 4.25 cc (2.5-7) DBX Mix was used per alveolar gap. Average age was 19 (17 – 23) years. Radiologic follow-up was 6 (2-10) months. Average Enemark scores improved from 3.4 to 1.2 (p<0.0001). Bone union was achieved in 9 (90%) patients and 14 alveolar bone gaps (93%). Graft and hardware extrusion occurred in 2 patients (20%); one patient was regrafted. A persistent alveolar fistula occurred in 1 patient (10% of patients; 7% of bone gaps). One patient (10%) required revision Lefort I osteotomy for relapse. No wound infections, bleeding requiring transfusion/reoperation, or mortalities occurred.
Conclusions: The use of allograft alone to reconstruct persistent alveolar clefts at the time of Lefort I advancement is a safe and effective alternative to traditional bone grafting. The use of allograft alone is associated with low morbidity, significantly improved Enemark scores, low relapse rates, and high bone union rates in patients that have previously failed traditional ABG.
