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Regrafting And Psychosocial Outcomes In Early Alveolar Bone Grafting For Cleft Lip And Palate Patients
Allison C. Hu, BA, Sri Harshini Malapati, BS, Candace H. Chan, BS, Nirbhay S. Jain, MD, Brian N. Dang, BS, Anthony A. Bertrand, MD, MBA, Libby F. Wilson, MD, PhD, Justine C. Lee, MD, PhD.
University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.

PURPOSE: Alveolar bone grafting (ABG) for cleft lip and palate (CLP) is typically performed during mixed dentition but prior to canine eruption, frequently around ages 8-10. However, we recently showed that surgical burden in CLP patients during ages 8-10 was associated with poorer psychosocial outcomes. Therefore, we sought to evaluate whether alveolar grafting at an earlier age in children with CLP affects regrafting rates and subsequent psychosocial functioning during their teenage and adult years.
METHODS: Patients with CLP who underwent ABG from the University of California, Los Angeles craniofacial clinic and the Orthopaedic Institute for Children were prospectively enrolled and administered the Patient Reported Outcomes Measurement Information Systems (PROMIS) short-form measures (anger 5a, anxiety 8a, depression 8a, and peer relationships 8a). Inclusion criteria included patients who underwent initial ABG at ages 0-13 and had a minimum two-year follow-up (n=118). Patient demographic, operative, and follow-up data were retrospectively collected. Regrafting rates were compared between patients who had early (4-7 years), standard (8-10 years), and late (11-13 years) alveolar bone grafting. To evaluate the potential long-term psychosocial effects of graft timing, PROMIS measures administered during teenage and adult years (≥14 years) in early ABG patients were compared to those in standard ABG patients. Chi-square and Fisher’s exact tests were used to analyze categorical variables and t-test was used to analyze continuous variables. Logistic and multivariate linear regressions were performed. A significance level of 0.05 for two-sided tests was used.
RESULTS: Overall, 118 patients with CLP (70 male, 59.3%) underwent initial ABG between ages 4-13. Mean age at time of ABG and PROMIS assessment was 9.2±2.1 and 15.1±1.1 years, respectively. Most patients had unilateral CLP (n=87, 73.7%). The average number of surgeries in this cohort was 6.1±3.0 (range 2-15). Of the patients who received alveolar bone regrafting (n=42, 35.6%), average time to regraft was 4.4±3.6 years. No significant differences in demographics, diagnoses, and regraft timing was demonstrated between early (age 4-7), standard (8-10), and late (11-13) ABG. However, regrafting rates were significantly different among the three groups (17.9% vs 37.0% vs 50.0%, p=0.030). Early ABG was associated with lower regrafting rates in CLP patients by logistic regression (beta=-1.550, p=0.014). In terms of psychosocial functioning, while no difference was found in peer relationships and anger between patients with early and standard ABG, early ABG patients had significantly lower levels of anxiety (42.11±6.51 vs 48.34±10.19, p=0.010) and depression (41.50±6.62 vs 47.18±9.03, p=0.031). Multivariate linear regression analyses similarly demonstrated that early ABG predicted decreased anxiety and depressive symptoms in CLP teenagers and adults (beta=-0.300, p=0.021 and beta=-0.231, p=0.036, respectively).
CONCLUSION: Early ABG is associated with lower regrafting rates and improved psychosocial outcomes in children with CLP.


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