Long Term Post-Operative Cone Beam Commuted Tomography Analysis of Secondary Bone Grafting in 79 Patients with Unrepaired Alveolar Clefts

Abstract Purpose Use cone-beam computed tomography (CBCT) analysis to assess the long term radiographic outcomes of early secondary alveolar bone grafting. Patients and Methods The most recent post-operative CBCT of 79 alveolar cleft patients that underwent of anterior iliac crest bone grafting (AICBG) by a single surgeon over 6 years and met all inclusion criteria was analyzed using the modified assessment tool. Clefts were measured vertically, horizontally and superiorly in terms of nasal support, then assigned corresponding scores of 0-4 to help determine radiographic success. The sites were interpreted as poor (0 or 1), acceptable (2 or above), or favorable (3 or above). Similarly, clefts overall (vertical + horizontal) were poor (0-3), acceptable (4 or above) or favorable (5 or above). Statistical analysis was used to characterize patient demographics, subgroup comparisons, and to identify factors specifically predictive of favorable outcomes. Results 79 patients with a total of 105 clefts were included. 60.8% were male, and 32.9% had a bilateral cleft. The average age at time of surgery was 8 years 0 months, and average time to furthest post-op CBCT was 2 years 8 months. The average scores were: vertical – 2.9 (4), horizontal – 3.1 (4), nasal support – 2.7 (4), cleft overall – 6.0 (8). All 79 patients were discharged on post op day #1 and the re-graft rate was 0%. Multivariate analysis demonstrated that younger patients had a significantly higher chance of achieving favorable results in terms of vertical scores (p=0.0081) and cleft overall scores (p=0.0204). The association with younger age and horizontal scores was marginally significant (p=0.0667), but there was no significant association between age and nasal support. Conclusions Younger patients have an improved long-term radiographic success of grafted alveolar clefts. This supports performing AICBG at a younger age on cleft lip patients.