Alveolar bone grafting: achieving the organisational standards determined by CSAG, a baseline audit at the Birmingham Children's Hospital

Abstract

Ann R Coll Surg Engl 2005; 87: 461-465 461The NHS is in constant change; the implementation of change is fraught with difficulty and the risk of short-term failure. Cleft services for the UK are no exception to this principle, and have undergone rigorous restructuring since the publication of the findings from Clinical Standards Advisory Group (CSAG) for cleft lip and palate in 1998.1 As a result of this, the West Midlands regional cleft service has become centralised to the Birmingham Children's Hospital (BCH). Our experience illustrates the practical difficulties that reorganisation has had on our specialty. However, the quality of service has improved subsequent to this implementation. This report provides data for national comparison.We report a retrospective clinical process audit taken from the hospital notes and a radiological assessment of one outcome measure for this service -the alveolar bone graft (ABG) success rate. We compare our results to the CSAG study findings prior to local implementation of its recommendations. We discuss the organisational shortfalls revealed by our audit and make proposals for local restructuring of the service based on our findings.We have chosen to measure alveolar bone grafting as our clinical outcome because of the availability of validation by Bergland scores 2 and because this parallels the main outcome measure used by CSAG for comparison. Bergland established a four-point assessment score of the inter-alveolar height after bone grafting. CSAG recognised types I and II as success and types III and IV as failure.The CSAG study identified 647 children under the care of 50 different cleft teams. Not all of these children had required alveolar bone grafting and 183 radiographs were (BCH) is the centre for a regional comprehensive cleft service attempting to implement the national guidelines for minimum standards of care. A national audit of cleft management (CSAG) found that 58% of alveolar bone grafts were successful; published series suggest that success rates can be of the order of 95%. We present the results of an audit of alveolar bone grafting over a 33-month period, after implementation.

Centralization of Services for Children Born with Orofacial Clefts in the United Kingdom: A Cross-Sectional Survey

“…The current study has fulfilled this recommendation in part by providing information about the current structure and processes in U.K. cleft care since recommendations for centralization in 1998. As yet, we have not examined associations between the structural rearrangement of the cleft service and clinical outcomes in the U.K. Other published work has reported improved outcomes for alveolar bone grafts (Clarkson et al, 2005) and dentoalveolar relations in 5-year-olds in a centralized model of care (Hathorn et al, 2006). As noted above, data collected for the CCUK study include child outcome and parental satisfaction data.…”

Difference in the Surgical Outcome of Unilateral Cleft Lip and Palate Patients with and without Pre-Alveolar Bone Graft Orthodontic Treatment

“…Some centers have intuitively recommended that orthodontic treatment becomes part of their treatment protocol for their patients 25 26 . However, this is the first randomized controlled study to evaluate the role of preoperative orthodontic treatment on ABG success.…”

Secondary Alveolar Bone Grafting (CLEFTSiS) 2007–2010

“…A significant number of studies have also used the anterior occlusal radiograph as the standard assessment tool (Hall and Posnick, 1983;Bergland et al, 1986aBergland et al, , 1986bEnemark et al, 1987;Demas and Sotereanos, 1988;Amanat and Langdon, 1991;Kortebein et al, 1991;Freihofer et al, 1993;LaRossa et al, 1995;Long et al, 1995;Kalaaji et al, 1996;Tan et al, 1996;Kindelan et al, 1997;CSAG, 1998;Montecinos et al, 1998;Denny et al, 1999;Kindelan and Roberts-Harry, 1999;Opitz et al, 1999;Aurouze et al, 2000;Jia and Mars, 2000;Lilja et al, 2000;Mao et al, 2000;Kalaaji et al, 2001;Williams et al, 2001;Jia et al, 2002;Witherow et al, 2002;Schultze-Mosgau et al, 2003;Nightingale et al, 2003;Williams et al, 2003;Clarkson et al, 2005;Trindade et al, 2005;Bayerlein et al, 2006;Jia et al, 2006;Rawashdeh and Nimri, 2007;Matic and Power, 2008;McIntyre and Devlin, 2010;Francis et al, 2013).…”