alveolar cleft grafting: clarifying the missing links
Alveolar cleft grafting (ACG) is part of the general management of patients with cleft lip and palate (CLP). It is considered an essential procedure for functional and esthetic rehabilitation of (CLP) patient. ACG is considered a technique sensitive procedure as its outcome is affected by several cumulative local and general factors.
Whenever a postoperative complication develops, the surgical outcome may be compromised and reoperation might be necessary. The need for reoperation increases the overall cost of treatment, exposes the patient to risks related to the operation and general anesthesia, and might even be a reason for the patient or family to refuse further treatment. Reoperation will also result in formation of more scar tissue and further compromise the local microcirculation and healing of hard and soft tissue.
Several variables may interfere with the outcomes of (ACG) and affect the stability of bone graft. Patient factors (such as age, status of tooth eruption on the cleft side, cleft width, ratio of cleft to nasal cavity and the patient’s general health and nutritional status). Moreover, there are surgical wound conditions (overall oral health, quality and amount of soft and hard tissue adjacent to the cleft, blood supply, scar tissue from previous operations and donor site). Finally, there are technical characteristics (graft material, and the surgeon’s experience) which may, with the previously mentioned factors, play a part in the surgical outcomes.
In order to improve the (ACG) procedures, it requires full awareness of all aspects and factors that contribute in its final outcomes and how to assess and manage. Neglection of these factors will compromise the prognosis of alveolar cleft grafting.
In this presentation, we will present our experience in optimizing outcomes of (ACG) at the Cleft Care Center over the past 10 years.