Postoperative Facial Edema Following Alveolar Bone Grafting: A Prospective Cohort Study

The secondary alveolar bone graft (ABG) is one of the key components in the treatment of cleft lip and palate. However, an ABG is commonly accompanied by postoperative facial edema. Although appropriate assessment of facial edema can facilitate the early detection of major postoperative complications, the usual course of swelling post-ABG is not yet fully understood. The present, prospective cohort study was conducted to clarify the typical course of facial swelling post-ABG.

Nineteen operations in 17 patients who underwent an ABG between September 2019 and August 2020 were enrolled. Postoperatively, facial photographs of each patient were taken on four consecutive days; then, the degree of swelling visible in the photographs was assessed by three plastic surgeons. This assessment was repeated one month later.

Both the first and the second assessments demonstrated an inter-rater agreement of 63.2%. Cohen's kappa values for the three possible rater combinations ranged 0.377-0.755 and 0.453-0.574 in the first and the second assessment, respectively. The intra-rater reliability was 77.2%, with a Cohen's kappa value of 0.543, indicating moderate agreement. The swelling peaked on postoperative day 2 and began improving from postoperative day 3.

These findings will hopefully help physicians treating alveolar clefts detect postoperative complications earlier and enable them to explain the prognosis of swelling to patients and their families with greater certainty.