Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Purpose: This study used 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 postoperative CBCT scans of 79 alveolar cleft patients who underwent anterior iliac crest bone grafting by a single surgeon over a 6-year period and met all inclusion criteria were analyzed using a modified assessment tool. Clefts were measured vertically, horizontally, and superiorly in terms of nasal support and then assigned corresponding scores of 0 to 4 to help determine radiographic success. The sites were deemed poor (score of 0 or 1), acceptable (score >= 2), or favorable (score >= 3). Similarly, overall clefts (vertical plus horizontal scores) were classified as poor (score of 0 to 3), acceptable (score >= 4), or favorable (score >= 5). Statistical analysis was used to characterize patient demographic characteristics, to perform subgroup comparisons, and to identify factors specifically predictive of favorable outcomes. Results: The study included 79 patients with a total of 105 clefts. Male patients comprised 60.8% of patients, and 32.9% of patients had a bilateral cleft. The average age at the time of surgery was 8 years 0 months, and the average time until the most recent postoperative CBCT scan was 2 years 8 months. The average scores were as follows: vertical, 2.9 (maximum score possible, 4); horizontal, 3 1 (maximum score possible, 4); nasal support, 2.7 (maximum score possible, 4); and overall cleft, 6.0 (maximum score possible, 8). All 79 patients were discharged on postoperative day 1, and the regraft rate was 0%. Multivariate analysis showed that younger patients had a significantly higher chance of achieving favorable results in terms of vertical scores (P = .0081) and overall cleft scores (P = .0204). The association between younger age and horizontal scores was marginally significant (P = .0667), but no significant association was found between age and nasal support. Conclusions: Younger patients have improved long-term radiographic success with grafted alveolar clefts. This finding supports performing anterior iliac crest bone grafting at a younger age in cleft lip patients. Published by Elsevier Inc. on behalf of the American Association of Oral and Maxillofacial Surgeons