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A Novel Protocol for Two-Stage Reconstruction of the Cleft Alveolus
Michael R Bykowski, Sanjay Naran, Wendy Chen, Renata Maricevich, Jesse A Goldstein, Joseph E Losee
University of Pittsburgh Medical Center
2015-03-15
Presenter: Wendy Chen
Affidavit:
The resident was responsible for development of the project idea, design of the study, collection of data, and analysis of data.
Director Name: Joseph E Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction:
The purpose of this study was to evaluate our protocol for two-stage alveolar bone grafting (ABG).
Methods:
Our research group conducted a retrospective analysis at a major metropolitan pediatric tertiary hospital between August 2008 to August 2014 for patients who underwent ABG. The decision to perform a one-stage versus two-stage repair was based on the senior author's clinical judgement related to difficulty.
Results:
All patients underwent an alveolar bone graft procedure (n = 85). Patients either underwent a one-stage procedure (n = 72) or a two-stage procedure (n = 8). Stage 1 included repair of a combination of Pittsburgh Fistula Classification System fistulae #4, #5, #6, and/or #7. Stage 2 involved bone grafting into either unilateral or bilateral cleft defects. Five patients were excluded from analysis that underwent Stage 1 but not Stage 2 (4 due to recent Stage 1 procedure and 1 lost to follow-up). Comparing one-stage to two-stage repairs, the following parameters were similar – respectively – age (9.6 vs 9.3 years of age; p=0.60), pre-maxillary setback (7% vs 25%; p = 0.09), requirement of re-do ABG (26.4% vs 25.0%; p = 0.94) and follow-up duration (2.5 vs 2.9 years; p = 0.60). Alloderm was used significantly more often in two-stage repair versus one-stage repair (100% vs 36%; p = 0.0004).
Conclusions:
Our two-stage protocol is a reasonable alternative for reconstruction of the cleft alveolus. This protocol allows for a safe, reliable way to successfully close the alveolar cleft to facilitate sufficient boney bridging to improve orthodontic tooth movement and facial appearance.
