One and Done: Combining Alveolar Bone Grafting With Revision Palatoplasty

Area of Science:

• Plastic Surgery
• Pediatric Surgery
• Speech-Language Pathology

Background:

• Patients with cleft lip and palate (CLCP) often require multiple surgical interventions.
• Revision palatoplasty addresses velopharyngeal insufficiency (VPI), while alveolar bone grafting (ABG) stabilizes the palate and closes fistulas.

Purpose of the Study:

• To evaluate the safety and efficacy of combining revision palatoplasty with alveolar bone grafting in pediatric CLCP patients.
• To compare outcomes of combined procedures versus individual procedures.

Main Methods:

• Retrospective review of 180 pediatric CLCP patients (2017-2024) undergoing ABG and/or revision palatoplasty.
• Patients categorized into ABG alone, revision palatoplasty alone (Palate), and combined ABG + Palate groups.
• Outcomes assessed via imaging for bone graft success, speech-language pathology for VPI, and clinical evaluation for fistula closure.

Main Results:

• Grafting success rates were similar between ABG alone and combined groups.
• The combined group showed comparable VPI improvement (88.9%) and fistula closure (100%) to the Palate alone group (83.7% VPI improvement, 92.3% fistula closure).
• Speech improved from moderate to mild hypernasality in both Palate and combined groups.

Conclusions:

• Combining revision palatoplasty with alveolar bone grafting is a safe and effective strategy for managing CLCP.
• This combined approach may reduce the overall number of surgical procedures for complex pediatric cases.