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Management of failed alveolar bone grafts: improved outcomes and decreased morbidity with allograft alone
Wesley N Sivak, MD, PhD
Zoe M MacIsaac, BA
S Alex Rottgers, MD
Joseph E Losee, MD
Anand R Kumar, MD
University of Pittsburgh
2012-02-12
Presenter: Wesley N Sivak
Affidavit:
The above work represents the sole work of the resident under guidance of the attending physician.
Director Name: Joseph E Losee
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
The paper meets objective #2 as it focuses on the management of cleft patients who have failed previous alveolar reconstruction.
How will your presentation be used by practicing physicians in the audience?
Conference attendees will learn that allograft materials are safe and effective in revision alveolar grafting. This study provides an alternative treatment for complex cleft patients.
Purpose: Demonstrate the safety and efficacy of allograft alone in patients requiring revision alveolar bone graft (ABG).
Methods: Retrospective review of our ABG experience with iliac crest bonegraft (ICBG), ICBG plus allograft, or allograft alone. Patients (n=47) were treated with alveolar fistula repair/primary closure.
Results: Group 1, ICBG alone, 17 unilateral/5 bilateral clefts (n=27) were treated in 22 patients (12 male/10 female, average age 10). Group 2, ICBG plus allograft, 6 unilateral/8 bilateral clefts (n=22) were treated in 14 patients (8 male/6 female patients, average age 9). Group 3, allograft alone, 7 unilateral/4 bilateral clefts (n=15) were treated in 11 patients (6 male/5 female, average age 13). Follow-up was 47.5, 12, and 3.5 months, respectively. Operative time/alveolus was 78 mins for Group 3, shorter than 147 and 111 mins for Groups 1 and 2, respectively (p<0.0005). Enemark score was 1.2 in Group 3, better than 2.0 in Group 1 (p<0.005) and similar to 1.1 for Group 2 (p>0.05). Revision ABG with allograft alone improved Enemark scores from 3.7 to 1.2 (p<0.0001). Hospital stay was 0.9 days for Group 3, shorter than 2.4 and 2.7 for Groups 1 and 2, respectively (p<0.0001). Graft extrusion occurred in 6 patients (27.3%) in Group 1, no complications occurred in Group 2, and a single central incisor was lost in Group 3 (9.1%). No infections, bleeding requiring transfusion/reoperation, or mortalities occurred.
Conclusion: Allograft alone in reconstruction of failed ABG is effective and provides a safe alternative to ICBG in short-term follow up.
