The facial esthetic of children with unilateral cleft lip and palate (UCLP) is significantly improved with early alveolar bone grafting (ABG) alongside rhinoplasty (R), versus leaving the procedure until the child is older, study findings show.
Both professional and lay raters scored the facial esthetics of the early ABG group significantly better 3 years postoperatively - reflecting a more attractive nasolabial appearance - than their not-yet-grafted counterparts of a similar age.
However, the researchers warn that the patients' growth and development could reduce the positive effect of ABG-R as they age.
Previous studies have identified that the nose is the least esthetic element of facial morphology in children with CLP, and inadequate skeletal support resulting from an alveolar defect is partially responsible for this, explain Piotr Fudalej (Palacky University Olomouc, Czech Republic) and colleagues.
"Hence, a rhinoplasty performed after or in combination with ABG might produce better results than nose surgery carried out prior to ABG," they hypothesize in Orthodontics and Craniofacial Research.
Early-grafted study participants included 29 nonsyndromic children aged a mean 5.3 years who underwent ABG-R between the ages of 2 and 4 years. The nongrafted group included 30 nonsyndromic children aged 5.5 years.
All participants had undergone one-stage closure of the entire cleft, aged a mean 7.2 and 9.1 months in the early- and nongrafted groups, respectively.
Five professional observers and 14 laypersons graded the children's' facial esthetics using the 5-point index devised by Asher-McDade et al, where a score of 1 denotes very good appearance and a score of 5 denotes very poor appearance.
Esthetic scores given to children in the early-grafted group were significantly better than those given to children who had not yet undergone ABG-R, report Fudalej et al, with mean scores of 2.46 versus 3.01 for full face, 2.30 versus 2.66 for nasal deviation, 2.42 versus 2.87 for nasal form, and 2.48 versus 2.87 for nasal profile.
Multivariate analysis revealed only one factor was minimally positively associated with the score for nasal profile: older age at one-stage repair of UCLP.
"A possible mechanism could be that when a one-stage repair of UCLP was performed later, more craniofacial growth had already taken place and less growth deficiency could be seen at 5 years," suggest the researchers.
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