Scott Deacon

Alveolar bone grafting: results of a national outcome study

INTRODUCTION In 1998, the Clinical Standards Advisory Group (CSAG) report demonstrated a successful radiographic outcome of 58%, for alveolar bone grafting, from 157 cases of unilateral cleft lip and palate (UCLP) in children aged 12 years. No further national studies have assessed the current level of radiographic outcome following the re-organisation of cleft services since the recommendations from the CSAG report. PATIENTS AND METHODS In 2008, radiographic images were requested for alveolar bone grafts performed in calendar year 2006 from each of the now established UK cleft centres. A sample of 206 patients with 235 grafted sites was scored by a panel of trained assessors, following a calibration exercise, using a modified Kindelan index. Inter- and intra-observer variation was assessed. RESULTS The overall radiographic success rate for the 2006 images assessed was 85%. There was no statistical difference for radiographic success between centres or surgeons or cleft type when defined as either a bilateral or unilateral alveolar defect for a patient. CONCLUSIONS Alveolar bone grafting appears to have improved radiographic outcomes when compared with the CSAG report following the re-organisation of surgical services for children with cleft lip and/or palate.

The Outcome for Secondary Alveolar Bone Grafting in the South West UK Region Post-CSAG

Objective In 1998 the delivery of cleft care in the United Kingdom was examined by the Clinical Standards Advisory Group, the outcomes of which led to the wide restructuring of cleft services in the United Kingdom. We present a retrospective study evaluating the radiographic outcome of 53 consecutively performed alveolar bone grafts following the regional centralization of secondary alveolar bone grafting to the South West Cleft Centre between 2004 and 2006. Methods A retrospective audit of one surgeons outcome of 53 consecutively performed alveolar bone grafts, assessed radiographically using the Kindelan method. Results That 94% of bone-grafted sites achieved a successful radiographic outcome compares favorably with the previously published Clinical Standards Advisory Group data of 58% with Bergland scores. Conclusion The radiographic outcome for alveolar bone grafting has improved with centralization. A small number of patients are being grafted after the ideal chronological age, and this needs to be addressed throughout the region. The Kindelan assessment provides a reliable method of early assessment for alveolar bone grafting.

Impact of Secondary Alveolar Bone Grafting on the Symptoms of Reflux in Oronasal Fistulas: A Patient-Related Outcome Study

Objective To establish for the first time the prevalence of fistula symptoms and the effectiveness of secondary alveolar bone grafting to treat these symptoms in a single surgeon cohort in Bristol, United Kingdom. Design Direct questioning of 233 consecutive patients with cleft before and after secondary alveolar bone grafting as to the presence of fistula symptoms. Setting Southwest and South Wales Cleft Centre, Frenchay Hospital, Bristol, United Kingdom. Participants Consecutive patients with cleft who were being treated for secondary alveolar bone grafting. Outcome Measure Patients reporting presence of fistula symptoms. Data collection on cleft type (unilateral, bilateral), date of birth, and age at secondary alveolar bone grafting. Results Of the 167 unilateral patients with cleft lip and palate and 66 patients with bilateral cleft lip and palate, 45% had symptoms of a fistula before alveolar bone grafting and 10% had symptoms of a fistula after surgery. There were no statistically significant differences between the presence of symptoms before or after secondary alveolar bone grafting between cleft types or by age at secondary alveolar bone grafting. Conclusion This is the first study examining the rates of fistula symptoms before and after secondary alveolar bone grafting in the United Kingdom. This study used the patient-centered outcome of the presence of symptoms as a way of measuring the presence of fistulas in this group. Secondary alveolar bone grafting reduces the incidence of symptomatic fistula in this setting.