(13) Complication Rates In Pediatric Cleft Lip and Palate Patients Receiving Secondary Alveolar Cleft Bone Grafts With Iliac Crest Bone Grafting: Review of 427 Cases in a Single Institution

Abstract: Introduction
: Iliac crest bone grafting (ICBG) has long been considered the gold standard for secondary alveolar reconstruction in pediatric patients with cleft lip and palate. It has been suggested that alveolar repair with bone morphogenetic protein (BMP) and demineralized bone matrix is a superior alternative due to avoidance of donor site morbidity, with similar complication rates. The purpose of this study is to investigate the overall complication rates and types in a large cohort of pediatric patients who underwent secondary alveolar cleft repair with ICBG, and to compare them to previously published complication rates for alveolar cleft repair undertaken with BMP and allogeneic bone grafting.

Methods
: A retrospective study was conducted for patients who received secondary alveolar reconstruction with ICBG at the University of Alabama between 2010 and 2021 by 2 surgeons over an 11-year period. Exclusion criteria were age greater than 18 years old at the time of repair, and lack of postoperative follow-up. Overall postoperative complications rates and types were analyzed.

Statistical methods:
Descriptive statistics, one-way ANOVA, Tukey’s Multiple Comparisons tests, ROUT’s outlier test (Q = .1%), and linear regression plots with a P value <.05.

Results
The study included 426 patients with a total of 557 alveolar clefts who underwent iliac crest bone grafting. There were 295 unilateral alveolar clefts, and 131 bilateral alveolar clefts. Average age at the time of surgery was 7.9 years. There were 215 females and 211 males. Average length of follow-up was 30.3 months. The average length of hospital stay was 1.04 days, but ranged from 1-11 days. Five patients stayed for 2 days, one patient stayed for 3 days, one patient stayed for 11 days, 419 stayed for one day. Overall, 39 patients had complications. These complications included pyogenic granuloma (11), persistent oronasal fistula (5), infections (6), other (9), keloid (3), hypoesthesia (3), hip discomfort (1). Complications rates were not related to the number of cleft sites (1 versus 2). The overall complication rate for all patients was 9.1%. The complication rate based on the number of repaired alveolar cleft sites was 7%. The overall complication rate of the hip harvest site was 2.3%.

Conclusion:
ICBG remains the gold standard for alveolar reconstruction in cleft lip and palate patients due to the overall lower complication rate as compared to previously published complication rates for alveolar reconstruction with rhBMP and allogeneic bone, and very low overall morbidity associated with the hip donor site. The overall complication rate in a cohort of 426 patients who underwent 557 alveolar cleft site repairs was 9.1%. This complication rate is lower than previously published complication rates for alveolar cleft repair with ICBG and rhBMP. The majority of complications involved the intra-oral repair site, as opposed to the hip harvest site.

References

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