Preoperative Alveolar Segment Position as a Predictor of Successful Gingivoperiosteoplasty in Patients with Unilateral Cleft Lip and Palate

Background: Gingivoperiosteoplasty (GPP) can avoid secondary alveolar bone graft (ABG) in up to 60% of patients with a cleft. However, preoperative predictors of success have not been characterized. This study reports on the preoperative alveolar segment position most favorable for successful GPP. Methods: Single-institution, retrospective review of patients with a unilateral cleft who underwent NasoAlveolar Molding (NAM). Alveolar segment morphology was directly measured from maxillary dental models created before and after NAM. Statistical analysis was performed to identify parameters associated with the decision to perform GPP and its success, defined as the absence of an eventual need for ABG. Results: 50 patients with a unilateral cleft who received NAM therapy were included in this study (40 underwent GPP, 10 did not). 18 alveolar morphology and position characteristics were tested including: cleft gap width, horizontal and vertical positions of the alveolar segments, alveolar step-off, and degree of alveolar segment apposition. Post-NAM vertical rotation of the greater segment and the percentage of segment alignment in the correct anatomical zone were statistically significant predictors to the decision to perform GPP (86% predictive power). Cleft gap, greater-lesser segment overlap, alveolar segment alignment, greater segment horizontal rotation, and alveolar segment width following NAM were significant predictors of GPP success (86.5% predictive power). Conclusions: Greater segment vertical rotation and proper alveolar segment anatomic alignment are positive predictors to the decision to perform GPP. Post-NAM evidence of proper alignment and direct contact between the alveolar segments were significant predictors of successful GPP. Financial Disclosure Statement: The authors have no financial relationships or conflicts of interest to disclose. Corresponding author: Roberto L. Flores, MD, 307 East 33rd Street, Lower Level, New York, NY, 10016 United States of America. roberto.flores2@nyumc.org ©2017American Society of Plastic Surgeons