Systematic review and meta-analysis of maxillary change among 3 surgical techniques in cleft patients

Abstract

Objective: The aim was to examine the treatment effectiveness and relapse of maxillary advancement, among 3 types of surgery in cleft patients: (1) conventional orthognathic surgery (CO), (2) extraoral distraction osteogenesis (EDO), and (3) intraoral distraction osteogenesis (IDO). Materials and methods: Using 6 electronic databases: Medline, Embase, Cochrane, ISI, Scopus, and Google Scholar. 336 cephalometric measurements were examined from 141 full text papers. For maxillary position, only SNA was eligible according to the criteria for meta-analysis. Heterogeneity test, estimation of pooled means, publication bias, and sensitivity analysis were performed. Results: Estimation of pooled means revealed the following results. The SNA at pre-treatment, post-treatment, and follow-up in CO group were 72.6, 77.6, 76.1 degrees, for EDO group were 74.4, 83.3, 83.1 degrees, and for IDO group were 73.3, 81.3, 82.1 degrees respectively. Indirect comparison of pooled mean estimate showed that the maxillary position was relatively similar at pre-treatment among the 3 groups. The maxilla was advanced +4.96 degrees in CO group, +8.93 degrees in EDO group, and +8.06 degrees in IDO group. At 1 year follow-up, the CO showed more relapse rate than EDO, however, small forward advancement was shown for IDO (−30.24%, −2.79% and +9.93% respectively). Limitations of study involved questionable quality of paper included as there was no RCT study. Conclusions: EDO and IDO might advance the maxilla greater than CO. Normalization of maxillary position was achieved using EDO and IDO, while the maxilla position in CO group was slightly retrognathic after surgery. At 1-year follow-up, CO showed greater relapse of SNA than EDO and IDO.

Keywords:

• Orthognathic surgery
• Extra-oral distraction osteogenesis
• Intra-oral distraction osteogenesis
• Cleft lip and palatecleft lip and palate
• Meta-analysis

Acknowledgements

The authors would like to acknowledge Faculty of Graduate Studies, Mahidol University. This study won the First prize postgraduate research competition of the Faculty of Dentistry, Mahidol University in 2011.