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Surgical Techniques in Unilateral Cleft Lip and Palate Repair and their effect on Maxillary Growth: A systematic review
STEVEN RUEDA MD
GABY DOUMIT MD
Cleveland Clinic Foundation
2013-03-15
Presenter: STEVEN RUEDA MD
Affidavit:
Director Name: Steven L Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND:
Surgical treatment of cleft lip and palate is well-known to have effects on the facial structures. Many studies analyzing various repair options are addressed in the literature, however there does not exist universal agreement among surgeons regarding which technique least negatively affects maxillary growth.
OBJECTIVE:
To evaluate the effect of surgical technique on facial growth in patients with unilateral cleft lip and palate with specific reference to dental arch morphology.
DESIGN:
Systematic review
METHODS:
A comprehensive search strategy of three major literature databases (Medline, Ovid, Cochrane)was performed. Results were supplemented by retrospective review of article references. Articles excluded from study met one or more of the following exclusion criteria: not in English language, published before 1980, cleft other than unilateral cleft lip and palate, no description of surgical technique, two stage cleft palate repair or simultaneous lip and total palate repair, unspecified age of surgery, follow-up of less than 4 years, age younger than 9mo or greater than 24mo at repair.
RESULTS:
Original search resulted in 491 abstracts.A total of 8 articles met inclusion criteria and were selected for final review. Retrospective review of references yielded 2 additional articles. Goslon Yardstick score was variable and contradictory across studies for each technique. However, there was a trend for improved outcomes in von Langenbeck technique compared to others. None of the techniques was found to be statistically superior. There was significant variability in methodology, outcome measurements, and low power across studies.
CONCLUSION:
There is need for prospective randomized controlled studies comparing different surgical techniques.
