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Cranial Bone Grafting for Alveolar Clefts: A 25-Year Review of Outcomes

Hudak, Kristen A. M.D.; Hettinger, Patrick M.D.; Denny, Arlen D. M.D.

Plastic and Reconstructive Surgery: May 2014 - Volume 133 - Issue 5 - p 662e–668e
doi: 10.1097/PRS.0000000000000109
Pediatric/Craniofacial: Original Articles

Background: Cranial bone grafting for an alveolar cleft obtains membranous bone from a low-morbidity donor site. Although iliac crest bone is the favored donor site, there are no objective analyses of three-dimensional radiologic outcomes with cranial bone grafting and no studies evaluating complications and long-term outcomes in a large series of patients undergoing cranial bone grafting.

Methods: A retrospective chart review was conducted on patients who underwent alveolar bone grafting from the cranium over a 25-year period performed by a single surgeon. Data collected included patient characteristics, complications, and clinical outcomes. Radiologic analysis of graft outcomes was determined using Amira volume-rendering software on the most recent 10 consecutive patients.

Results: The authors’ study cohort included 308 patients, with an average age of 11.5 years. Complications involved harvesting the graft in 3.5 percent, the donor site in 1 percent, and the recipient site in 17.2 percent. Regrafting was required in 7.1 percent, with a clinical success rate of 92.9 percent. The average alveolar defect was 1.19 ml preoperatively and 0.19 ml postoperatively, with 85 percent fill of the cleft defect by radiologic analysis.

Conclusions: Cranial bone grafting for the alveolar cleft is a low-morbidity operation and has success similar to that of iliac crest bone grafting. It should be considered more often as a viable option for the alveolar cleft patient.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Milwaukee, Wis.

From the Department of Plastic Surgery, Medical College of Wisconsin.

Received for publication September 17, 2013; accepted October 18, 2013.

Disclosure: The authors have no financial interests to report. No outside funding was received.

Arlen D. Denny, M.D., Department of Plastic Surgery, Children’s Hospital of Wisconsin, P.O. Box 1997, Suite C340, Milwaukee, Wis. 53201-1997, adenny@chw.org

©2014American Society of Plastic Surgeons