Early Alveolar Bone Grafting Is Associated with Lower Regraft Rates and Improvements in Long-Term Psychosocial
Allison C Hu1, Nirbhay S Jain1, Candace H Chan1
1From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine; and Cleft Palate Program, Orthopaedic Institute for Children.
Insights
Altering the timing of alveolar bone grafting for cleft lip and palate patients to an earlier age (4-7 years) reduces reoperation rates and improves long-term psychosocial outcomes, decreasing anxiety and depressive symptoms.
Area of Science:
- Craniofacial surgery
- Pediatric surgery
- Psychosocial outcomes
Background:
- Late childhood interventions for cleft and craniofacial anomalies correlate with worse long-term anxiety and depressive symptoms.
- Surgical timing for cleft lip and palate reconstruction may require adjustment.
- Alveolar bone grafting is a common surgical procedure during late childhood for these patients.
Purpose of the Study:
- To investigate the outcomes of altering the timing of alveolar bone grafting in cleft lip and palate patients.
- To assess the impact of earlier alveolar bone grafting on surgical success and long-term psychosocial well-being.
Main Methods:
- A two-part, multi-institutional cohort study.
- Retrospective comparison of reoperation rates for alveolar bone grafting at different ages (4-7, 8-10, 11-13 years).
- Prospective administration of the Patient-Reported Outcomes Measurement Information System (PROMIS) psychosocial suite to assess long-term outcomes.
Main Results:
- Early grafting (4-7 years) showed the lowest reoperation rates.
- Patients grafted at an earlier age reported significantly lower levels of anxiety and depressive symptoms in adolescence and adulthood.
Conclusions:
- Adjusting the timing of alveolar bone grafting to an earlier age is feasible and beneficial.
- Earlier alveolar bone grafting decreases reoperation rates and enhances long-term psychosocial health in cleft lip and palate patients.
Background:
Late childhood (8 to 10 years of age) has emerged as a vulnerable period in children with cleft and craniofacial anomalies such that increased interventions during this period are associated with worse long-term patient-reported anxiety and depressive symptoms. These findings suggest that one possible practice change may be to consider changes in timing for surgical treatment algorithms. In this work, the authors investigated outcomes in altering the timing of the most common operation in late childhood for cleft lip and palate patients, alveolar bone grafting.
Methods:
A two-part, multi-institutional cohort study was conducted. To understand the feasibility of changing alveolar bone graft timing with respect to surgical success, reoperation rates were retrospectively compared among patients grafted at different ages (4 to 7, 8 to 10, and 11 to 13 years of age). To understand the long-term effect of changing alveolar bone graft timing on psychosocial outcomes, the psychosocial suite of the Patient-Reported Outcomes Measurement Information System was prospectively administered to teenagers and adults with cleft lip and palate.
Results:
Among the three age groups, early grafting (4 to 7 years of age) demonstrated the lowest regraft rates compared with the other groups. As these results suggested that early grafting is a viable alternative to standard timing, we next compared the differences in long-term psychosocial outcomes. Patients who were grafted early reported lower levels of anxiety and depressive symptoms as teenagers and adults.
Conclusion:
Altering timing of one stage in cleft lip and palate reconstruction to an earlier age decreases regraft rates and improves long-term patient-reported anxiety and depressive symptoms.
Clinical Question/Level Of Evidence:
Therapeutic, III.
