Association Between Repeat Alveolar Bone Grafting and Anxiety in Teenagers with Cleft Lip and Palate
Hi'ilani M. K. Potemra, BS1, Fransia S. De Leon, BA1, Claire Liu, BS1, Miles J. Pfaff, MD1, James P. Bradley, MD2, Libby F. Wilson, MD3, Justine C. Lee, MD, PhD1.
1University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA, 2Division of Plastic and Reconstructive Surgery, Northwell Health Hofstra School of Medicine, New York, NY, USA, 3Cleft Palate Program, Orthopaedic Institute for Children, Los Angeles, CA, USA.
In patients with cleft lip and palate (CLP), secondary alveolar bone grafting (ABG) is accompanied with a 20-30% regrafting rate due to insufficient bone stock for orthodontic rehabilitation. Due to various factors including pain and the age at which bone grafting is performed, we hypothesized that regrafting may contribute to psychosocial distress in children with CLP. In this study, we evaluate the relationship between alveolar bone regrafting and long term psychosocial functioning in patients with CLP.
Patient Reported Outcome Measurement Information Systems (PROMIS) short-form measures (anger 5a, anxiety 8a, depression 8a, and peer relationships 8a) were administered to patients with CLP from the craniofacial clinics at the University of California, Los Angeles (UCLA) and the Orthopaedic Institute for Children (n=120). We obtained demographic information from patients' medical records, including age at psychosocial assessment, total number of surgeries, whether or not they underwent a regraft surgery, and at what age the regraft surgery was performed. To evaluate the psychosocial functioning of patients who have completed ABG we selected children ages 14-17 (n=41). Two-tailed independent samples t-tests were conducted to compare psychosocial functioning of CLP ABG patients with a history of regraft surgery (n=11) and those without (n=30). A general linear model univariate analysis was conducted to determine if there was a significant interaction between regraft versus no regraft and total number of surgeries. A level of p<0.05 was considered statistically significant.
All patients had their initial ABG at the average age of 10.07±2.27 years. 26.8% of these patients required a regraft and had the regraft surgery at a mean age of 11.00±1.73 years. Patients with a history of regraft reported no significant difference in anger, depression, and peer relationship outcomes compared to those with no regraft. However, patients with CLP who underwent a regraft reported significantly higher anxiety levels (54.60±6.34 vs.45.05±9.1; p=0.003) than patients who did not. The general linear model demonstrated no significant interaction between history of regraft surgery and total number of surgeries, suggesting that regrafting was an independent surgical predictor for increased anxiety.
Increased surgical burden during childhood has been associated with decreased psychosocial functioning in teenagers. Identifying methods of decreasing psychosocial distress during childhood is necessary to improve psychosocial functioning in adolescence, especially in patients with a history of regraft. History of alveolar bone regraft surgery is independently associated with higher self-reported anxiety levels in teenagers with cleft lip and palate.
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