One and Done: Combining Alveolar Bone Grafting With Revision Palatoplasty

Patients with cleft lip and cleft palate (CLCP) require multiple interventions for structural and functional deficits. Revision palatoplasty may be performed during childhood for velopharyngeal insufficiency (VPI), while alveolar bone grafting (ABG) is performed during mixed dentition to stabilize the maxillary arch and close oronasal fistulas. This study evaluates the safety and efficacy of combining revision palatoplasty with ABG. A retrospective review was conducted of pediatric patients with CLCP who underwent ABG and/or revision palatoplasty at an academic children's hospital (2017-2024). Data included demographics, surgical indications, operative characteristics, and outcomes. Patients were grouped by procedure: ABG alone, revision palatoplasty alone (Palate), and combined ABG + Palate. Bone graft success was confirmed by imaging ≥ 6 months postoperatively. Revision outcomes were assessed via speech-language pathology (VPI improvement) and clinician evaluation (fistula closure). Among 180 patients included, 100 (55.6%) underwent ABG alone, 66 (36.7%) underwent Palate alone, and 14 (7.8%) underwent ABG + Palate. Grafting methods and success rates were similar between the ABG and ABG + Palate groups. The ABG + Palate group had a higher age at VPI diagnosis compared with the Palate group (8 versus 5 y, P = 0.02) but similar time to revision (4 mo). Both Palate and ABG + Palate groups showed comparable VPI improvement (83.7% versus 88.9) and fistula closure rates (92.3% versus 100%), with speech improvement from moderate to mild hypernasality. Combining revision palatoplasty with ABG is safe and effective, potentially minimizing the number of surgeries in this complex patient population.