J. Silvestre1, O. Jackson1 1The Children’s Hospital Of Philadelphia,Division Of Plastic Surgery,Philadelphia, PA, USA
Introduction: Cleft lip and palate are repaired in infancy, but full oral rehabilitation cannot progress without alveolar bone grafting (ABG) surgery. ABG is necessary to achieve stability of maxillary segments and provide the necessary bony support for tooth eruption. Delays in ABG can adversely affect orthodontic treatment and overall outcomes.
Methods: We conducted a retrospective study of patients receiving ABG surgery at a large, urban cleft referral center. Patient charts were reviewed for demographic and clinical data. The primary outcome of interest was age at ABG. Race was defined as Caucasian, Asian, Hispanic, or African American, with minority status given to Hispanic and African American. Insurance status was defined as public or private. Only non-syndromic patients with clefts involving the alveolus who received all cleft care at our institution were included in this study. A multivariate regression model was used to determine the impact of clinical and demographic variables on ABG timing. For purposes of comparison, Kruskal-Wallis and Mann-Whitney U tests were used with P values <0.05 considered significant.
Results: 233 patients underwent ABG surgery at 8.1 ± 2.3 years of age. African American and Hispanic patients received delayed ABG surgery compared to Caucasian patients by approximately one year (P < 0.05). There was no difference in ABG surgery timing by insurance status (P > 0.05).
Conclusions: The timing of ABG surgery varies by race, but not by insurance status. Greater resources may be needed to insure timely delivery of cleft care to African American and Hispanic children.