Day-case alveolar bone grafting in cleft patients: a two-part retrospective and prospective feasibility study

Abstract

Alveolar bone grafting (ABG) is an essential procedure for the treatment of cleft alveolus and palate defects, promoting maxillary continuity, dental eruption, functional rehabilitation, and symmetrical facial development. Traditionally performed as an inpatient procedure due to pain management concerns, recent efforts have explored its feasibility as day-case surgery. A two-phase study was conducted. First, a retrospective analysis of 12 ABG cases (July 2023–February 2024) evaluated postoperative pain management and feasibility. This was followed by a prospective pilot study involving 17 patients (March–August 2024), who underwent ABG as day cases under a structured protocol. Pain scores, analgesic requirements, and patient/parent feedback were recorded and analysed. The retrospective analysis concluded that effective pain control was achieved with oral analgesia within six hours postoperatively. In the prospective cohort, mean pain scores were 2.2/10 for the oral site and 2.5/10 for the hip donor site, managed with oral paracetamol and ibuprofen, with minimal opioid use (<30%). No significant complications were reported. Transitioning to day-case ABG reduced bed shortage-related cancellations and was preferred by patients. Day-case ABG is a feasible and safe alternative to inpatient care when strict selection criteria and structured protocols are implemented. This approach optimises resource utilisation, minimises cancellations, and enhances patient satisfaction. Larger studies are warranted to confirm these findings and facilitate broader implementation.