Introduction
Author | Outcome measures | Incidence of complications (%) | Number of patients | Study design | Country of origin | Follow-up time |
---|---|---|---|---|---|---|
Present study | Complications: an adverse effect directly related to the surgical procedure | 29.7 | 64 | Retrospective cohort | Netherlands | 3–13 years |
Scott et al. 2017 | Success of bone graft, canine eruption, fistula, morbidity | 27 | 44 | Retrospective cohort | UK | 1.4–14.6 years |
Scott et al. 2007 | Premaxilla mobility, wound dehiscence, recurrent oronasal fistulas | 20 | 15 | Retrospective cohort | UK | > 3 months |
Freihofer et al. 1993 | Failure: loss of 50% of bone graft, residual fistulas | 15 | 22 | Retrospective cohort | Netherlands | Mean (21 months) |
Borba et al. 2014 | Wound dehiscence, infection of the wound, resorption of the graft | 36 | 71 | Retrospective cohort | Brazil | ≥ 1 year |
Jia et al. 2006 | Bergland criteria and eruption of the canine | 46 | 28 | Retrospective cohort | China | 1–8 years |
Shirani et al. 2012 | Need for revision surgery because of insufficient bone height | 44 | 44 | Retrospective cohort | Iran | Mean (33.35 months) |
Carlini et al. 2009 | Integration of the bone graft, premaxilla mobility, residual fistulas | 10 | 50 | Prospective cohort | Brazil | 1 year |
Rawashdeh et al. 2006 | Bergland criteria | 20 | 15 | Retrospective cohort | Jordan | 6 months–5 years |
Jia et al. 1998 | Bergland criteria, wound dehiscence, infection | 33 | 55 | Retrospective cohort | UK | 1–10 years |
Materials and methods
Surgical protocols
Primary closure
PO and bone grafting
Preoperative parameters
Complications
Statistical analysis
Results
Baseline characteristics
Variable | Number of patients (n = 64) | Percent of total | Years |
---|---|---|---|
Preoperative data | |||
Sex | |||
Male | 38 | 59.4 | |
Female | 26 | 40.6 | |
Patients with syndromes | 4 | 6.25 | |
Race | |||
Caucasian | 49 | 76.6 | |
Non-Caucasian | 15 | 23.4 | |
Mean age at time of surgery | 11.37 years | ||
Follow-up period | 3.1–13.4 years (mean: 7.72 years) |
Complications (n) | Percent | |
---|---|---|
Early major complications with revision surgerya | 18 | 28.1 |
Total graft loss | 6 | 9.38 |
Bone resorption | 1 | 1.56 |
Wound dehiscence | 3 | 4.69 |
Bone sequestration | 1 | 1.56 |
Necrosis of the premaxilla | 2 | 3.13 |
Oronasal fistula | 5 | 7.81 |
Late minor complications | 1 | 1.56 |
Infraposition of the premaxilla | 1 | 1.56 |
Total complications | 19 | 29.7 |
Weighted kappa | Standard error of kappa | 95% CI | |
---|---|---|---|
Intrarater agreement | |||
Malposition of the premaxilla | 0.52 | 0.09 | 0.35–0.69 |
Preoperative bone quality around cleft-related teeth | 0.27 | 0.06 | 0.14–0.40 |
Gingival health | 0.66 | 0.09 | 0.43–0.80 |
Time of grafting | 0.84 | 0.07 | 0.70–0.97 |
Interrater agreement rater 1 versus 2 | |||
Malposition of the premaxilla | 0.67 | 0.07 | 0.52–0.81 |
Preoperative bone quality around cleft-related teeth | 0.75 | 0.07 | 0.61–0.88 |
Gingival health | 0.62 | 0.09 | 0.45–0.79 |
Time of grafting | 0.78 | 0.08 | 0.62–0.93 |
Analysis of postoperative complications
Variable | Category | Number of patients (total for variable)a | Number (%) of patients with complicationsb | p value |
---|---|---|---|---|
Sex | Male | 38 (64) | 12 (31.58) | 0.689 |
Female | 26 (64) | 7 (26.92) | ||
Preoperative bone quality around cleft-related teeth | Good | 43 (63) | 8 (18.60) | |
Poor/fair | 20 (63) | 11 (55) | 0.003* | |
Position of the premaxilla | Reasonable position | 33 (64) | 6 (18.18) | 0.038* |
Displaced (intermediate/severe) | 31 (64) | 13 (41.94) | ||
Canine present in cleft | Yes | 18 (64) | 4 (22.22) | 0.358 |
No | 44 (64) | 15 (34.09) | ||
Gingival health | Good | 32 (61) | 10 (31.25) | 0.617 |
Average | 27 (61) | 9 (33.33) | ||
Bad | 2 (61) | 0 (0) | ||
Deciduous teeth around cleft area | Yes | 52 (62) | 14 (26.92) | 0.147 |
Time of grafting | Early secondary | 37 (63) | 7 (18.92) | 0.020* |
Late secondary | 26 (63) | 12 (46.15) | ||
Graft type | Chin | 55 (64) | 16 (29.09) | 0.796 |
Iliac crest | 9 (64) | 3 (33.33) |
Cases with complications | Cases without complications | OR | 95% CI | p value | |
---|---|---|---|---|---|
Age versus complications | 19 | 45 | 1.4 | 1.013–1.92 | 0.041* |
Age > 12 years versus complicationsa | 11 | 53 | 5.9 | 1.49–23.93 | 0.011* |
Preoperative bone quality around cleft-related teeth versus complications | 20 | 43 | 5.3 | 1.66–17.21 | 0.005* |
Malposition of the premaxilla versus complications | 19 | 45 | 3.3 | 1.04–10.13 | 0.042* |
Age versus reoperation | 18 | 46 | 1.4 | 1.02–1.97 | 0.034 |
Age > 12 years versus reoperationa | 18 | 46 | 6.68 | 1.65–26.99 | 0.008* |
Gingival health versus complications | 19 | 42 | 1.1 | 0.368–3.288 | 0.865 |
Time of grafting | Number of patients | Mean age (years) | Standard deviation (years) | p value |
---|---|---|---|---|
Early secondary | 37 | 10.81 | 1.39 | 0.002* |
Late secondary | 26 | 12.19 | 2.00 | |
Missing | 1 | 11.00 | – |