GP6d - Is There a Difference in Postsurgical Complications between Alloplastic and Allogeneic Bone Grafting following Le Fort I Osteotomy?

Abstract: Statement of the problem:
Widening, advancing, and/or inferiorly repositioning the maxilla during Le Fort I osteotomy provides challenges to the surgeon secondary to interpositional bony gaps created across the osteotomy. Although several studies investigate the use of autogenous and non-autogenous bone graft materials to help overcome such challenges, there is a scarcity in the literature regarding the use of allogeneic bone as a bone graft substitute. The aim of the present study is to evaluate differences in postsurgical complications following use of allogeneic and alloplastic bone graft substitutes during Le Fort I osteotomy.

Materials and methods:
This retrospective study involved analysis of electronic medial records of all patients who underwent Le Fort I osteotomy with internal rigid fixation and grafting over an 8-year period. A total of 233 records were reviewed, and subjects grafted with exclusively autogenous bone graft, grafted with multiple bone substitute types, or with less than 6 months follow-up were excluded. The study sample included 97 patients who were divided into 2 groups based on the bone graft material used; Group 1: porous block hydroxyapatite (PBHA); and Group 2: allogeneic iliac tricortical bone. Incidence of graft dehiscence, surgical site infection, and non-union was recorded for each group.

Method of data analysis:
A Chi-square test of independence was performed to examine the relation between bone graft substitute and incidence of postsurgical complications. A P-value of less than .05 was considered statistically significant.

Results:
The patients’ mean age at surgery in Group 1 was 20 years and in Group 2 was 29 years. Average follow-up in each group was 9 months. The overall incidence of postsurgical complications was 9.97%, and 11.76% in Group 1 and 7.94% in Group 2. There were no statistically significant differences in postsurgical complications between Group 1 and Group 2 . Patients younger than 37 years of age had fewer postsurgical complications (5.56%) when compared to those over the age of 37 years (20.00%) (P < .05). Patients with concomitant mandibular orthognathic surgery had lower graft healing complication incidence (6.98%) as compared to isolated Le Fort I osteotomy patients (27.27%) (P < .05).

Conclusion:
Both bone graft materials have comparable graft-related complication rates in Le Fort I osteotomies. Incidence of complications is lesser in younger patients and those undergoing concomitant mandibular orthognathic surgery. The need for autogenous bone grafting in maxillary surgery could be questioned based on the results of this study.

References:
1. Alyahya A, Swennen G: Bone grafting in orthognathic surgery: a systematic review. Int J Oral Maxillofac Surg 48:3:322-31, 2019

2. Posnick J, Sami A: Use of allogenic (iliac) corticocancellous fraft for Le Fort I interpositional defects: technique and results. J Oral Maxillof Surg 73:168:e1-12, 2015