Iliac Crest Pain in Alveolar Cleft Bone Grafting

BACKGROUND: Harvesting cancellous bone graft from the iliac crest is a standard procedure for alveolar cleft reconstruction. However, donor-site pain remains a major clinical concern. A modified trephine technique was developed to address this problem. This study evaluated postoperative pain at the iliac crest after cancellous bone graft harvesting. METHODS: Thirty-one patients with alveolar clefts underwent cancellous bone grafting during the mixed dentition period. The iliac crest was accessed through a small skin incision, the overlying cartilaginous cap was removed, and cancellous bone was harvested using a trephine technique while preserving muscle and fascial attachments. Postoperative pain at both the oral recipient and iliac crest donor sites was assessed from postoperative day (POD) 1 to POD 14 by using the 11-point Numeric Rating Scale, which was completed by patients and parents. RESULTS: On POD 1, the average pain score was 3.7 at the oral recipient site and 5.1 at the iliac crest donor site. By POD 7, the average pain scores at the oral recipient and iliac crest donor sites decreased to 0.7 and 1.2, respectively. Patients reported greater, similar, or lower pain at the iliac crest than at the oral recipient site during the postoperative period. Pain at both sites decreased by 50% by POD 4 and reached minimal levels after 1 week. Ambulation was achieved by all patients on POD 1. CONCLUSION: The modified trephine technique for cancellous bone graft harvesting resulted in reduced donor-site pain at the iliac crest, facilitating early ambulation and recovery.