Graft Outcomes With or Without Use of Cortical Bone Graft for Nasal Floor Reconstruction in Unilateral Cleft Lip and Palate

<i>Objective</i>Evaluate the use of cortical bone grafts (CBGs) for nasal floor reconstruction on alveolar bone graft (ABG) outcomes in unilateral cleft lip and palate (UCLP).<i>Design</i>Retrospective cohort study.<i>Setting</i>North-American cleft centers.<i>Subjects</i>Fifty-three children with nonsyndromic UCLP treated with secondary ABG.<i>Methods</i>Center 1 (<i>n</i> = 23) utilized CBG for nasal floor reconstruction, while Centers 2 (<i>n</i> = 10), 3 (<i>n</i> = 10), and 4 (<i>n</i> = 10) did not. Occlusal radiographs, taken 6 to 18 months after ABG, were assessed by 6 calibrated raters using the Standardized Way to Assess Grafts (SWAG) Scale. Weighted kappa statistics measured intra and interrater reliabilities. SWAG scores comparisons in the apical, middle, and coronal thirds of the alveolar cleft were conducted between the centers. The Kruskal-Wallis test was used to determine significant differences, with a <i>P</i>-value of <.05 considered statistically significant.<i>Results</i>Intrarater reliability was very good (κ = 0.858), and interrater reliabilities were good (κ = 0.717). Significant differences were initially found in overall SWAG scores across centers (<i>P</i> = .003), with Center 1 achieving the highest mean overall SWAG score (5.16 ± 0.99) compared to Centers 2, 3, and 4 (4.48 ± 1.37, 4.58 ± 1.44, and 3.72 ± 0.65, respectively). Center 4 exhibited statistically significant lower scores compared to Centers1, 2, and 3, and was excluded from secondary analyses. After exclusion, no significant differences remained among Centers1, 2, and 3 (<i>P</i> = .135) for overall SWAG scores or apical third SWAG scores (where CBG is inserted). No significant differences were observed in the middle (<i>P</i> = .055) or coronal (<i>P</i> = .131) thirds across centers.<i>Conclusions</i>CBG in secondary ABG procedures for CUCLP patients showed outcomes comparable to cancellous-only grafts, with a trend toward improved apical scores in CBG-treated patients.