A 2-Stage Approach to Alveolar Cleft Repair with Combined Cortical and Cancellous Bone Grafting

Background: Achieving optimal efficacy in secondary alveolar bone grafting (SABG) poses a considerable challenge for patients with alveolar clefts after canine eruption. This study introduces a novel technique called the “2-stage SABG” to improve the treatment outcomes for patients who have missed the optimal timing for bone grafting. Methods: Patients aged 12 years and older, presenting with unilateral, complete alveolar clefts after canine eruption, were divided into 2 cohorts: conventional and 2-stage groups. The 2-stage group underwent oronasal fistula closure and mucoperiosteal sealing during the initial stage, followed by particulate cancellous bone marrow and mandibular cortical bone grafting in the second stage after a 3-month interval. Six months after surgery, the SABG was evaluated quantitatively and qualitatively using computed tomography. Results: A total of 81 patients (median age, 14 years; 49 men and 32 women) were included in the conventional group, and the 2-stage group consisted of 33 patients (median age, 19 years; 20 men and 13 women). The 2-stage group exhibited significantly superior outcomes ( P < 0.01) in terms of radiographic healing rate (>4 points) (96.97% versus 55.56%), bone bridge height (12.17 mm; interquartile range [IQR], 4.26 mm), bone bridge width (9.09 mm; IQR, 2.74 mm), bone formation rate (69.73%; IQR, 22.73%), and bone resorption rate (48.85%; IQR, 22.57%). In addition, the average 3-dimensional deviations were greater than 3.5 mm at the affected piriform aperture margin. Conclusion: The novel 2-stage SABG approach demonstrates significant benefits in the repair of alveolar clefts and pyriform foramen deformities through combined cortical and cancellous bone grafting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.