Effect of Nutrition on the Outcomes of Alveolar Cleft Grafting: A Baseline Audit

Abstract

Orofacial clefts are the commonest congenital anomalies of head and neck and present in about 1/700 live births through the world. (1) The best treatment option for a cleft lip and palate patient (CLP) requires a multidisciplinary team approach. However, the most accepted approach for the management of patients with craniofacial anomalies according the American Cleft Palate-Craniofacial Association (ACPA) guidelines, is the presence of specialists’ interdisciplinary team. (2,3) There are three basic operations for CLP patients; the first one is the surgical repair of cleft lip which should be within the first 12 weeks of life. The surgical closure of cleft palate should be done by the age of 18 months and good results are achieved when it is earlier. Finally, the closure of residual alveolar cleft which should be grafted before the permanent maxillary teeth eruption in the cleft region and the timing of the operation should be collaborated with the orthodontist. (3) The technique of choice remains the Secondary alveolar grafting, where early secondary grafting is done at 6-8 years of age; while secondary grafting is done at 9-12 years of age and finally the late secondary grafting is done after eruption of the canine. (4) The bone graft source depends on the size (volume) of the defect. Ideally, cancellous iliac bone graft harvested from the anterior iliac crest is always the bone graft source of choice. (4) According to the Clinical Standards Advisory Group (CSAG), success of the Alveolar Bone Grafts is 58%. Assessment of the Alveolar cleft grafting (ACG) can be done using the Bergland scale