More than 25% of patients with cleft lip and palate (CLP) develop hyperplasia of the maxilla that requires surgical correction. This surgery is usual occurs in the final phase of their CLP treatment and is typically a Le Fort I osteotomy. The aim of this review was to assess the long term stability of this procedure in patients with CLP.
What did they do
The databases, PubMed; MEDLINE; EMBASE; ISI Web of Science; Evidence-Based Medicine Reviews–Cochrane Central Register of Controlled Trials; All Evidence-Based Medicine Reviews, comprising the Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects and HealthSTAR were searched with no language restrictions. Randomized and nonrandomized controlled clinical trials, clinical trials, case series studies, and prospective and retrospective studies were included but , case reports with 5 or fewer subjects, animal studies, systematic reviews, meta-analyses, and editorials were excluded. Study quality was scored using a checklist developed by one of the authors.
What did they find
- 10 studies met the inclusion criteria , Only 1 study a randomised trial was considered to be of high quality, meta-analysis was not possible owing to the heterogeneity of the outcome measures.
- After maxillary advancement with Le Fort I in patients with cleft lip and palate,
- the long-term horizontal relapse at the A-point was 20% to 30% in 4 studies and 30% to 40% in 3 studies.
- vertical relapse was more than 50% in 4 studies.
- The one high-quality study reported a 37% rate of horizontal relapse and a 65% rate of vertical relapse at the A-point.
Current evidence suggests maxillary surgical advancement with conventional Le Fort I osteotomy in patients with cleft lip and palate appears to show a moderate relapse rate in the horizontal plane and a high relapse rate in the vertical plane.
Saltaji H, Major MP, Alfakir H, Al-Saleh M, Flores-Mir C. Maxillary Advancement With Conventional Orthognathic Surgery in Patients With Cleft Lip and Palate: Is It a Stable Technique? J Oral Maxillofac Surg. 2012 Jun 5. [Epub ahead of print] PubMed PMID: 22677329
All but two of the study designs included in the review were retrospective. It is also worth noting that systems to score quality are not recommended by the Cochrane Collaboration which now uses a domain based risk of bias assessment tool.
Scolozzi P. Distraction osteogenesis in the management of severe maxillary hypoplasia in cleft lip and palate patients. J Craniofac Surg. 2008 Sep;19(5):1199-214. Review. PubMed PMID: 18812842.
Cheung LK, Chua HD. A meta-analysis of cleft maxillary osteotomy and distraction osteogenesis. Int J Oral Maxillofac Surg. 2006 Jan;35(1):14-24. Epub 2005 Sep 8. PubMed PMID: 16154316