Facial Growth of Patients With Complete Unilateral Cleft Lip and Palate Treated With Alveolar Bone Grafting at 6 Years

Doucet, Jean-Charles; Russell, Kathy; Daskalogiannakis, John; Mercado, Ana; Emanuele, Nicholas V.; James, L J; Hathaway, Ronald; Long, Ross E.

doi:10.1177/1055665618792791

Cited by 22 publications

(27 citation statements)

References 30 publications

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“…There are numerous studies suggesting maxillary growth issues when bone grafting is performed at too young of an age, namely in the infant (Hathaway et al, 2011). Newer evidence suggests that while primary ABG has detrimental effects on growth, this issue seems not to occur when grafts are performed on 6-year olds (Doucet et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Earlier Bone Grafting, Prior to Orthodontic Treatment, on SWAG Ratings of Graft Outcomes

Lowry

Long

Russell

et al. 2020

The Cleft Palate-Craniofacial Journal

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Objective: To compare the outcomes between 2 groups of patients with complete clefts treated with early secondary alveolar bone grafting (ABG) at 2 centers (5-7 years, before orthodontic intervention) and to a third group of patients treated at one of those centers (center 1) who had received later secondary ABG (8-10 years, after orthodontic intervention). Design: Blind retrospective analysis of cleft site radiographs using Americleft Standardized Way to Assess Grafts (SWAG) scale. Patients: A total of 99 patients with complete clefts from 2 North American cleft/craniofacial centers. Interventions: Secondary ABG representing 2 protocols: early grafting at a mean age of 6.6 years prior to any orthodontic intervention, and later grafting at a mean age of 10.2 years following pregrafting orthodontic intervention. Main Outcome Measures: Using occlusal radiographs, the SWAG scale from 0 (failed graft) to 6 (ideal) was used. Six trained, calibrated raters scored each radiograph twice, with the average of the 2 ratings used as the final score. Reliability was assessed using the weighted κ statistic. The significance of differences between groups was determined using the Kruskal-Wallis test and Dunn test for pairwise comparisons. Results: Inter-rater reliability of SWAG method was good (0.631). Intra-rater reliability was excellent (0.817). There was a tendency for improved total graft outcome in the early grafted group from center 1 compared to the later grafted group with improvement being significantly different in only the coronal third of the early, preorthodontic grafted group. However, the difference was not statistically significant for the graft overall.

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Section: Discussionmentioning

confidence: 99%

The Effect of Earlier Bone Grafting, Prior to Orthodontic Treatment, on SWAG Ratings of Graft Outcomes

Lowry

Long

Russell

et al. 2020

The Cleft Palate-Craniofacial Journal

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“…Although the consecutive sample evaluated by Fudalej et al comprised patients in whom SABG was carried out after 8 years of life, the alteration in the timing of SABG did not negatively affect craniofacial growth as shown in the current investigation. It is possible that our highly effective protocol of the primary cleft repair allowed for earlier timing of SABG and at the same time the successful treatment outcome reported in the literature (Talmant et al, 2002; Doucet et al, 2018).…”

Section: Discussionmentioning

confidence: 93%

Effects of Different Timing of Alveolar Bone Graft on Craniofacial Morphology in Unilateral Cleft Lip and Palate

Brudnicki¹,

Sawicka²,

Brudnicka³

et al. 2019

The Cleft Palate-Craniofacial Journal

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Objective: To evaluate the effect of the timing of secondary alveolar bone graft (SABG) on craniofacial morphology in patients with complete unilateral cleft lip and palate (UCLP). Design: Single-center retrospective assessment of consecutively treated nonsyndromic patients with complete UCLP. Participants: One hundred sixty-seven patients (108 males, 59 females) with complete UCLP in whom the cleft was repaired with 1-stage method at approximately 8 months of age. The age of 128 patients at SABG varied from 1.4 to 11.5 years (SABG group), while 39 patients still awaited SABG at the moment of cephalometric evaluation (no-SABG group). Methods: Craniofacial morphology was assessed on lateral cephalograms taken at 10 years of age (standard deviation = 0.8; range: 7.5-12.3) using linear and angular measurements. T tests and regression models were made to analyze data. Results: Regression models demonstrated that the effect of SABG on the craniofacial morphology was limited—cephalometric variables which were statistically significantly different between SABG and no-SABG groups showed no association with the timing of SABG when (1) age of primary repair of the cleft, (2) age of cephalometric evaluation, (3) cleft side, (4) gender, and (5) operator were controlled for. Only the length of the maxilla (Condylion-point A) was affected—1-year delay of SABG corresponded with an increase in Co-point A distance by 0.52 mm. However, adjusted R 2 of the model was 0.11. Conclusions: Our findings cautiously indicate that SABG performed before 8 years of age can have limited negative effect on craniofacial morphology. Nevertheless, our results should be confirmed by cleft centers practicing alternative surgical repairs of the cleft.

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“…In line with this, one can observe the recent tendency to perform SABG earlier than previously recommended [8,[13][14][15][16][17]. Nevertheless, a definitive conclusion cannot be reached [18] and the relationship between the timing of SABG and its long-term outcome is still debated.…”

Section: Introductionmentioning

confidence: 81%

“…The main reason for this postponement was the fear of potentially more significant interference with maxillary growth at younger age and subsequent maxillary restriction [5][6][7]. These assumptions were questioned by the later studies, partly based on long-term observations of matured patients-they implied that SABG had comparable influence on subsequent maxillary growth regardless of its timing [8][9][10][11]. Furthermore, it has been proved that SABG at an earlier age is associated with less donor-site morbidity and definitely does not increase donor site symptoms, surgical duration or hospitalization following surgery [12].…”

Section: Introductionmentioning

confidence: 99%

Alveolar Volume Following Different Timings of Secondary Bone Grafting in Patients with Unilateral Cleft Lip and Palate. A Pilot Study

Brudnicki¹,

Regulski

Sawicka³

et al. 2021

JCM

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This study was intended to evaluate the relationship between secondary alveolar bone grafting (SABG) timing and the alveolar volume in patients with unilateral cleft lip and palate (UCLP). The material consisted of CTs of 35 patients (17 males, 18 females) with UCLP who underwent a one-stage primary cleft repair at a mean age of 8.4 months and SABG at different timings ranges of 1.8–18.8 years. The mean age at CT was 17.2 years. The relative coefficient (Ꞷ) which was independent from factors such as individual maxillary size, gender or age at the CT was introduced in order to compare volumes of the cleft-side in relation to the non-cleft-side alveolus. Pearson correlation coefficient r between Ꞷ coefficient and SABG timing was weak negative (r = −0.34, p = 0.045). The multiple regression analysis implied that the dependent variable-Ꞷ coefficient was associated with independent variables (cleft repair and SABG timings and age at CT) with r2 = 0.228. Only patient’s age at SABG explained the dependent variable (p = 0.003). The study cautiously indicates a tendency to larger alveolar volume following earlier timing of SABG. Nevertheless, the further research on a larger group of patients should be performed before formulating any clinical indications.

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Facial Growth of Patients With Complete Unilateral Cleft Lip and Palate Treated With Alveolar Bone Grafting at 6 Years

Abstract: Early secondary ABG around 6 years of age did not result in reduced midface projection as assessed by SNA and thus did not compromise anterior maxillary growth.

Cited by 22 publications

References 30 publications

The Effect of Earlier Bone Grafting, Prior to Orthodontic Treatment, on SWAG Ratings of Graft Outcomes

The Effect of Earlier Bone Grafting, Prior to Orthodontic Treatment, on SWAG Ratings of Graft Outcomes

Effects of Different Timing of Alveolar Bone Graft on Craniofacial Morphology in Unilateral Cleft Lip and Palate

Alveolar Volume Following Different Timings of Secondary Bone Grafting in Patients with Unilateral Cleft Lip and Palate. A Pilot Study

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