Autologous Bone Grafting With Adjunctive Use Of Acellular Dermal Matrices For Alveolar Cleft Defects: Early Outcomes
Julio A. Clavijo-Alvarez, MD, PhD, Lisa Vecchione, DMD, MDS, Gary DeCesare, MD, Chetan Irwin, BS, Darren M. Smith, MD, Joseph E. Losee, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
PURPOSE: Secondary alveolar bone grafting (ABG) remains the standard for alveolar cleft repair. Compromised oral or nasal closure may impede healing and result in graft failure or persistent fistulae. Incorporating acellular dermal matrix (ADM) into these repairs may protect the bone graft during mucosal healing by providing an additional layer of soft tissue coverage.
METHODS: A retrospective review of ABGs at our cleft-craniofacial center between 2005-2007 was performed. The use of ADM for nasal or oral lining augmentation was determined. A minimum 3 months follow-up was required for inclusion. Outcomes included: 1) mucosal disruption, 2) time to complete mucosal healing, 3) bone graft exposure, 4) post-operative bone graft incorporation utilizing the Chelsea scale, and 5) canine eruption through the graft site.
RESULTS: Thirty-six patients in total were included. 16 patients (4 female, 12 male) (8 Veau III, 8 Veau IV) received ADM for mucosal augmentation (6 nasal, 1 oral, 9 nasal and oral lining). Average age at surgery was 10 yrs (range 9-16 years). Average follow-up was 22 months (range 3 - 35 months). Mucosal disruption occurred 19% in the ADM group and 30% in the control group (p=NS). Complete mucosal healing was achieved at an average of 5 weeks (range 1-14 weeks) in the ADM group versus 4 weeks (range 2-11 weeks) in the control group (p=NS). Exposure of bone graft occurred 0% in the ADM group and 30% in the control group (p=0.016). The Chelsea scale demonstrated no significant radiographic difference in post-operative bone graft incorporation between the ADM and control groups. Canine eruption through the graft site was similar for both groups.
CONCLUSIONS: These data support the conclusions that utilizing ADM to augment nasal/oral mucosal lining in ABGs: 1) does not increase mucosal disruption or time to complete healing, 2) prevents post-operative bone graft exposure, and 3) appears to have no negative effect in post-operative bone graft incorporation or canine eruption through the graft site.