Gerhard K P Bittermann1, Robert J J van Es2, Adrianus P de Ruiter2, Michael H Frank3, Arnold J N Bittermann4, Aebele B Mink van der Molen5, Ron Koole2, Antoine J W P Rosenberg2. 1. Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands. g.k.p.bittermann@umcutrecht.nl. 2. Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands. 3. Department of Oral and Maxillofacial Surgery, Haaglanden Medical Centre, PO Box 432, 2501 CK, The Hague, The Netherlands. 4. Department of Pediatric Otorhinolaryngology, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB, Utrecht, The Netherlands. 5. Department of Plastic Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
Abstract
OBJECTIVE: To evaluate factors affecting incidence of complications after secondary alveolar bone grafting with premaxillary osteotomy (SABG + PO) in children with complete bilateral cleft of lip and palate (BCLP). MATERIALS AND METHODS: Data were collected from children with BCLP treated with SABG + PO from 2004 to 2014 at our institute. Preoperative parameters included age, donor site, race, gingival health, bone quality around cleft-related teeth, premaxilla position, graft timing, presence of canines in the cleft, and presence of deciduous teeth around the cleft area. Logistic regression and the chi-squared test were used to assess correlations and the incidence of complications. RESULTS: In the 64 patients, a significant correlation was found between complication rate and timing of bone grafting with respect to early versus late SABG + PO (p = 0.041), age > 12 years (p = 0.011; odds ratio (OR) 5.9; 95% confidence interval (CI) 1.49-23.93), malposition of the premaxilla (p = 0.042; OR 3.3; 95% CI 1.04-10.13), and preoperative bone quality around cleft-related teeth (p = 0.005; OR 5.3; 95% CI 1.6-17.2). CONCLUSIONS: The timing of SABG + PO is essential, as early SABG + PO is associated with fewer complications. A malpositioned premaxilla and poor bone quality around cleft-related teeth are associated with more complications. Therefore, preoperative orthodontic repositioning of the malpositioned premaxilla before SABG + PO should be considered. CLINICAL RELEVANCE: Analysis of treatment protocols and complications for BCLP patients underscores that proper timing of SABG + PO and correct premaxilla repositioning help reduce complications.
OBJECTIVE: To evaluate factors affecting incidence of complications after secondary alveolar bone grafting with premaxillary osteotomy (SABG + PO) in children with complete bilateral cleft of lip and palate (BCLP). MATERIALS AND METHODS: Data were collected from children with BCLP treated with SABG + PO from 2004 to 2014 at our institute. Preoperative parameters included age, donor site, race, gingival health, bone quality around cleft-related teeth, premaxilla position, graft timing, presence of canines in the cleft, and presence of deciduous teeth around the cleft area. Logistic regression and the chi-squared test were used to assess correlations and the incidence of complications. RESULTS: In the 64 patients, a significant correlation was found between complication rate and timing of bone grafting with respect to early versus late SABG + PO (p = 0.041), age > 12 years (p = 0.011; odds ratio (OR) 5.9; 95% confidence interval (CI) 1.49-23.93), malposition of the premaxilla (p = 0.042; OR 3.3; 95% CI 1.04-10.13), and preoperative bone quality around cleft-related teeth (p = 0.005; OR 5.3; 95% CI 1.6-17.2). CONCLUSIONS: The timing of SABG + PO is essential, as early SABG + PO is associated with fewer complications. A malpositioned premaxilla and poor bone quality around cleft-related teeth are associated with more complications. Therefore, preoperative orthodontic repositioning of the malpositioned premaxilla before SABG + PO should be considered. CLINICAL RELEVANCE: Analysis of treatment protocols and complications for BCLP patients underscores that proper timing of SABG + PO and correct premaxilla repositioning help reduce complications.
Entities:
Keywords:
Alveolar cleft; Bilateral cleft lip and palate; Pediatric dentistry; Premaxillary osteotomy; Reoperation; Secondary alveolar bone grafting
Authors: Gerhard K P Bittermann; Ad P de Ruiter; Nard G Janssen; Arnold J N Bittermann; Aebele M van der Molen; Robert J J van Es; Antoine J W P Rosenberg; R Koole Journal: Clin Oral Investig Date: 2015-09-16 Impact factor: 3.573