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A systematic review of surgical techniques for wide alveolar cleft repair
Isaac Mordukhovich, Fiona Fragomen, Abigail Meyers MD, Antonio Rampazzo MD PhD
Cleveland Clinic Department of Plastic Surgery
2024-02-01
Presenter: Isaac Mordukhovich
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. All work on this project represents the original work of the authors.
Director Name: Antonio Rampazzo MD PhD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Objective: This study is a comprehensive analysis of surgical techniques and outcomes for wide (≥ 8 mm) alveolar cleft repair.
Methods: A PRISMA-adherent systematic review was conducted. Study inclusion criteria required surgical technique descriptions and wide alveolar cleft repair outcomes. Review articles and redundant patient data across articles were excluded. Complications were defined as events necessitating surgical revision.
Results: Twenty-one retrospective cohort studies and 30 case studies/series published 1987-2022 met inclusion criteria, representing 501 patients aged 4 to 66 years (mean 15.43 plus/minus 5.21 years). Distraction osteogenesis was the most common technique (57.59% of patients; mean age 13.30 plus/minus 3.44 years), predominantly by incremental distraction (mean distraction rate 0.80 plus/minus 0.22 mm/day). 98.37% of orthognathic surgery patients (26.94% of cases; mean age 14.41 plus/minus 1.01 years) had undergone prior cleft repair surgeries. Only free flaps (4.99% of cases; mean age 23.14 plus/minus 13.74 years) and local flaps (10.80% of cases; mean age 17.16 plus/minus 8.63 years) were used in papers with mean ages over 35 years, although no significant differences in mean reported patient ages were found between techniques (F = 0.95, one-way ANOVA). Local flaps had lower soft tissue closure frequencies than other treatments (p < 0.00096, Tukey HSD test), but did not differ in osseous closure rates (p = 0.12, Kruskal-Wallis) and complication rates (p = 0.28, Kruskal-Wallis).
Conclusion: Every wide alveolar cleft repair technique evaluated in this review poses its own merits, offering surgeons a breadth of options for customizing treatment plans to the individual patient.
