Speech and Burden of Secondary Surgical Interventions Following One-Stage Repair of Unilateral Cleft Lip and Palate and Alveolar Bone Grafting Performed at Different Timings

Timing of Alveolar Bone Graft and Barriers to Care

OBJECTIVE

The current standard timing for alveolar bone grafting (ABG) occurs during mixed dentition, typically between the ages of six and twelve. A delay in receiving this operation is associated with an increase in graft loss and an overall thinner maxilla. This study aims to determine whether socioeconomic barriers are associated with a delay in timely ABG.

DESIGN

A retrospective analysis of patients who received ABG at our institution since 2012. Patient demographics, cleft classifications, operative details, and surgical dates were examined. A logistic regression model was created using socioeconomic variables to predict patients receiving delayed ABG. Significant variables were then included in a backwards selection logistic regression, followed by a final analysis of maximum likelihood estimates.

SETTING

Single-institution, primary cleft care center.

PATIENTS

202 patients with cleft palates who underwent ABG.

INTERVENTIONS

ABG.

MAIN OUTCOME MEASURES

Timing in which patients received ABG: standard (6-12 years) and delayed (>12 years).

RESULTS

Female sex was a protective factor in the timing of ABG in our initial univariate analysis (OR = 0.44; p  =  .015). Socioeconomic factors resulting in delayed presentation for ABG include median income (OR = 1.0; p  =  .018) and public insurance status (OR = 3.75; p < .001). Median income, sex, and driving distance to the cleft clinic were not significant following backward elimination, however, private insurance status remained significant (OR = 3.71; p  =  .0001).

CONCLUSION

Patients with public insurance are approximately 3.75 times more likely to receive ABG during permanent dentition. Multidisciplinary teams should work closely with patients on public insurance to ensure timely delivery of ABG.Level of Evidence III, Retrospective.

Age at Initial Cleft Lip Repair Among Children in Al Madinah Region

BACKGROUND

 Cleft lip and palate consists of a wide spectrum of anomalies affecting the oral cavity and lips and can have enduring adverse effects on health. The age at which surgical interventions are done is crucial as it can influence the outcomes. This study aimed to determine the age at which initial cleft lip repairs were performed and the proportion of individuals who underwent additional surgeries to address post-repair complications.

METHODS

 A cross-sectional study involving 120 participants was conducted. Data was collected by distributing an online questionnaire to parents of children who had undergone initial cleft lip repair in the Al Madinah region.

RESULTS

 The study found that the average age for the initial cleft lip repair in Medina is 0.46 ± 0.27 years. Post-repair complications were observed, including hearing loss in 10.9% of children, heavy breathing issues in 32.8%, an imbalance in facial expression in 47.9%, and swallowing problems in 3.4% of children even after surgery. Approximately 40% of parents sought further procedures to mitigate complications.

CONCLUSION

 The study indicated that the first cleft lip repair in Medina typically occurs during the first year of life. However, more extensive research is needed to assess the efficacy of procedures within the city. Further studies should be conducted to provide a more comprehensive understanding of these conditions and the outcomes of their treatments.