In-Depth Volumetric Analysis of Alveolar Cleft Defects Using Three-Dimensionally Printed Models

One-Stage Repair of Alveolar Cleft and Nasal Deformities Using Grafts From Nasal Septum: Application of Vomer, Ethmoid, and Septal Cartilage

BACKGROUND

Patients with alveolar cleft unrepaired suffer from nasal deformities of different magnitude. Bone and cartilage grafts are harvested through several incisions. In this study, we present a method to simultaneously correct nasal deformities and repair alveolar cleft using grafts from the nasal septum.

PATIENTS AND METHODS

All 6 patients with unilateral cleft lip and palate have alveolar cleft unrepaired combined with nasal deformity. Computed tomography scans and 3-dimensional-printed models of vomer and ethmoid bone were used for the purpose of preoperative design and for assessing the magnitude of deformity. Grafts of bone and cartilage from deviated septum were harvested by septoplasty through which dorsum deviation was corrected. Bone grafts from vomer and ethmoid were then fixed to the prepared alveolar cleft to repair the defect and elevate the alar base. Septal cartilage was adjusted into different shapes of grafts and deformities of nasal tip, nostrils, and columella were then corrected by rhinoplasty to restore the symmetry of the nose.

RESULTS

Symmetry of nostrils was improved. The height of alar base on the cleft side was elevated to the level close to the noncleft side. Deviation of the septum, nasal dorsum, and columella was corrected. Projection of the nasal tip was adjusted to facial midline. Midface aesthetics was generally improved.

CONCLUSION

Application of septal grafts reduce the number of incisions. One-stage repair of alveolar cleft and nasal deformities, with the aid of digital design, improves the postoperative experience and the general outcome of the surgery.

Evaluation of the CBCT imaging accuracy in the volumetric assessment of unilateral alveolar cleft

INTRODUCTION

Appropriate radiographic evaluation is a fundamental step for determining the topography of the defect before the surgical intervention for alveolar bone grafting. Evaluation of cleft volume by CBCT has been done in dry skull samples in previous studies and it was recommended as an effective tool in the volumetric evaluation of the bone defect prior to the surgery. The purpose of this study was to evaluate the accuracy of preoperative clinical use of CBCT¹ imaging in determining the alveolar cleft volume.

MATERIAL AND METHODS

We performed a clinical study. 20 patients with unilateral alveolar cleft underwent preoperative radiographic evaluation using CBCT scan. Volumetric measurement was performed by an oral and maxillofacial radiologist using 0.5, 1, and 2 mm slices and an oral and maxillofacial surgeon using 2 mm slices. After the closure of the nasal floor and palatal mucosa, the alveolar defect was clinically measured with putty impression material. Descriptive and bivariate statistics were computed and the p-value was set at 0.05.

RESULTS

This study showed that there is a statistically significant difference between CBCT-estimated and clinical volumes of the alveolar cleft (paired T-test, p-value < 0.05).

CONCLUSION

Considering the significant difference between clinical and CBCT-estimated volumes of the alveolar cleft, CBCT imaging is not considered an accurate tool for pre-operative volumetric assessment of the alveolar cleft.

Intra- and Interobserver Reliability of Bone Volume Estimation Using OsiriX Software in Patients with Cleft Lip and Palate Using Cone Beam Computed Tomography

The objective of the current study was to evaluate intra- and interobserver bone volume measurements and effect of orientation on the reliability of bone volume evaluation in as-acquired vis-à-vis oriented cone beam computed tomography scans using Osirix software and possible correlation between gender, age, and bone volume required. For this, 31 cone beam computed tomography (CBCT) scans of 14 girls and 17 boys (aged 9–13) with unilateral cleft lip and/or palate who met the inclusion criteria were analyzed. Efficacy and reliability of third party software Osirix for bone volume calculation was assessed using as acquired and oriented volumes by three specialists (a radiologist, an orthodontist, and an oral maxillofacial surgeon). The dataset and readings were anonymized to prevent any bias. Two-way mixed model analysis on as-acquired and oriented observations exhibited intra-class coefficient (ICC) values ≥ 0.90. Wilcoxon signed rank test (p = 0.10) and Kruskal–Wallis ANOVA (p = 0.46) indicated that although a clinical difference in volume assessment was seen between as-acquired and oriented observations (inter-observer and intra-observer), it was statistically insignificant. Spearman’s bi-variate correlation analysis revealed a significant relation between the type (side) of cleft and bone volume required to fill the defect (p < 0.05). Although there was clinical difference in bone volume measurement by the three observers, it was insignificant statistically. Clefts on the left side in the patients had significantly more bone required than the right side, whereas age and gender had no relation with bone needed to fill the defect. OsiriX software provided good reliability in measurements of bone volume.