Patients with cleft lips and palates face the tremendous surgical, medical, and dental burdens needed to address the multiple challenges associated with their condition. Our goal should be to minimize the number of procedures performed, improve outcomes, and minimize morbidity. For patients with unrepaired alveolar clefts, our focus results in 2 fundamental questions: 1) Which graft material is best? 2) When should grafting occur? Our center has seen improved outcomes with predictable results using the anterior iliac crest bone graft and performing the graft before the eruption of the maxillary central incisors. This is early secondary bone grafting and has been widely accepted by other cleft centers. However, the data supporting any single surgical method have been limited owing to the small patient series, variations in protocols, poor documentation across treating centers, and lack of agreed on objective measurement outcomes. We initially tried to measure our results using an existing radiographic tool. However, that proved challenging for a variety of reasons. Most radiographic imaging protocols have been based on 2-dimensional radiographs, which inherently fail to encapsulate the complexity of the alveolar cleft anatomy. Alternatively, the use of cone-beam computed tomography resulted in analyses that were too labor intensive for clinical application or large patient series, or the results generated were complex, making practical interpretation or statistical analysis more difficult. Therefore, we created a modified assessment tool (MAT) that included the strengths of the previous tools but simplified the data collection process and streamlined the outcomes. Our goal was for the MAT to become a standardized part of clinical documentation to not only provide surgeons with an objective method to evaluate their outcomes and aid with treatment planning decisions but also to allow for collaboration of data across centers for research purposes. Although our MAT was not validated in the study, the parameters were largely determined from previously validated scales. The MAT also is more qualitative than quantitative and does not provide volumetric data. After the initial learning curve, each individual analysis ultimately required only a few minutes from opening the scan to the final documentation of the results. The use of the MAT was readily learned and implemented by the faculty and residents. The fundamental key point from our study is that the results have clearly demonstrated that patients who undergo grafting at a younger age will have more predictably favorable radiographic outcomes. However, some of the unanticipated benefits of the project included creating a database of patients that can be easily updated in the clinic and developing a more streamlined protocol for follow-up and imaging intervals. Finally, the MAT proved to be a straightforward, concise, practical, and efficient method of objectively measuring the outcomes of our alveolar cleft bone graft technique for patients with cleft lip and palate.
Read full abstract
Oct 29, 2020
Debashreeta Nanda 
Open Access
