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Reinforcing the Mucoperiosteal Pocket with the Scarpa Fascia Graft in Secondary Alveolar Bone Grafting: A Retrospective Controlled Outcome Study

Lonic, Daniel, M.D.; Yamaguchi, Kazuaki, M.D.; Chien-Jung Pai, Betty, D.D.S.; Lo, Lun-Jou, M.D.

Plastic and Reconstructive Surgery: October 2017 - Volume 140 - Issue 4 - p 568e-578e
doi: 10.1097/PRS.0000000000003696
Pediatric/Craniofacial: Original Articles
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Background: Secondary alveolar bone grafting is the gold standard for the treatment of alveolar clefts in cleft lip and palate patients. The authors present a modified method using a Scarpa fascia graft that is placed deep into the mucoperiosteal pocket for watertight sealing of the bone graft chamber and limiting the graft position to the alveolar region for bony stability and tooth support. The outcome was assessed for clinical success in terms of bone graft stability and infection rate.

Methods: Seventy-four unilateral complete cleft lip and palate patients were enrolled in this retrospective study consisting of equal-size Scarpa fascia and control groups of consecutive unilateral complete cleft lip and palate patients undergoing secondary alveolar bone grafting. Occlusal radiographs of the alveolar cleft taken at least 1 year postoperatively were evaluated for Spearman correlated Bergland and Witherow scales. Statistical evaluation was conducted using t test, chi-square test, and odds ratio.

Results: The clinical success rate (Bergland types I and II) of the Scarpa fascia procedure was significantly higher (67.6 versus 94.6 percent, respectively), with a significantly lower infection rate (16.2 versus 2.7 percent, respectively) and a high correlation of Bergland and Witherow scales (0.964; p < 0.001). There was no wound dehiscence, fistula, bone graft exposure, or additional donor-site morbidity in the Scarpa fascia group.

Conclusion: The authors’ new method of alveolar bone grafting with the Scarpa fascia graft is safe and effective, and has one of the highest documented success rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Taoyuan, Taiwan; Munich, Germany; and Osaka and Tokyo, Japan

From the Departments of Plastic and Reconstructive Surgery and Craniofacial Orthodontics and the Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University; MFACE KieferGesichtsZentrum München and HELIOS Hospital Munich West; Shonan Beauty Clinic; and Shonan Medical Memorial Hospital,

Received for publication November 21, 2016; accepted April 4, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Lun-Jou Lo, M.D., Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kwei Shan, Taoyuan, Taiwan 333, lunjoulo@cgmh.org.tw

Copyright © 2017 by the American Society of Plastic Surgeons