A systematic review of wide alveolar cleft repair techniques

Wide alveolar clefts impair secondary alveolar bone grafting due to deficient mucoperiosteal tissue for grafted bone coverage. Consequently, preparatory or alternative techniques are often required for closure of such defects. We conducted a PRISMA-adherent systematic literature review on wide alveolar cleft repair to compare treatment efficacies and patient populations. With this information, we provide guidance on the relative advantages and disadvantages of each examined method. Forty-two studies published from 1987-2022 were included, containing 332 patients treated with distraction osteogenesis (52.1%), orthognathic surgery (33.1%), local flap (8.1%), or free flap (6.6%) repair. There were no significant differences in patient ages between distraction osteogenesis device types (p = 0.401, Kruskal-Wallis) or treatment intervals, except that tooth-borne consolidation was significantly faster than bone-borne consolidation (p < 0.01, one-way analysis of variance [ANOVA] with Tukey honestly significant difference test). Orthognathic surgery and free flap patients were more likely to have prior failed cleft reconstructions than those who underwent distraction osteogenesis or local flap repair (p < 0.05, chi-square test of independence), suggesting a "second-line" designation to orthognathic surgery and free flap repair. Orthognathic surgery also had significantly higher osseous closure rates than other treatments (p < 0.0125, chi-square test with Bonferroni correction). Younger patients more often received orthognathic surgery or distraction osteogenesis whereas older patients received free or local flaps (p < 0.05, Welch's one-directional ANOVA with Games-Howell test). Each of the techniques evaluated have unique features regarding patient age, recovery duration/complexity preferences, and treatment history. Although the ideal treatment may differ between patients, orthognathic surgery and free flaps appear to be the most effective techniques for wide alveolar cleft repair.