RESUMO
OBJECTIVE: To assess if a 4-point, radiographically based scale could be used between operators to reliably assess the success of secondary alveolar bone grafting. DESIGN: The study was retrospective with the clinicians blind to patient identity. Radiographs were examined twice by two clinicians with 1 week between assessments. SETTING: The research was carried out in a hospital-based orthodontic/oral and maxillofacial unit. PATIENTS: All patients who had secondary alveolar bone grafting in this unit between February 1992 and March 1995 were included in this study. There were 38 patients with a total of 48 grafted sites. INTERVENTIONS: The bone graft site was radiographed following orthodontic expansion prior to grafting. The radiograph was repeated postoperatively at a mean of 4 months after surgery. MAIN OUTCOME MEASURE: The degree of bony fill in the cleft area was assessed using a 4-point scale: Grade 1 > 75% bony fill; Grade 2 50-75% bony fill; Grade 3 < 50% bony fill; Grade 4 no complete bony bridge. RESULTS: Overall, 50% of grafts achieved grade 1, 23% were grade 2, 22% grade 3, and 5% grade 4. Levels of intra- and inter-observer agreement were highly variable (.33 to .72 kappa statistic). CONCLUSIONS: The 4-point scale described could be used to assess the success of autogenous secondary alveolar bone grafting. It showed moderate to substantial intra-observer agreement, and fair-to-moderate inter-observer agreement.
Assuntos
Processo Alveolar/anormalidades , Alveoloplastia/métodos , Transplante Ósseo/diagnóstico por imagem , Fissura Palatina/cirurgia , Adolescente , Adulto , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Criança , Fenda Labial/complicações , Fenda Labial/cirurgia , Fissura Palatina/complicações , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Avaliação de Resultados em Cuidados de Saúde , Radiografia , Estudos Retrospectivos , Método Simples-CegoRESUMO
The role of low level (Le Fort I) osteotomy of the maxilla alone, or combined with a mandibular procedure, is discussed for the management of maxillary hypoplasia at the supra-apical level which is commonly associated with repaired cleft lip and palate. Osteotomy at this level influences the soft tissue contours of the nasolabial region of the face. The changes in the soft tissue that can be expected and attained are examined. A brief description of operative procedures and fixation techniques is given and the possible causes of relapse considered.
