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Distraction osteogenesis versus orthognathic surgery for the treatment of maxillary hypoplasia in cleft lip and palate patients: a systematic review
Author(s) -
Austin S. L.,
Mattick C. R.,
Waterhouse P. J.
Publication year - 2015
Publication title -
orthodontics and craniofacial research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.664
H-Index - 55
eISSN - 1601-6343
pISSN - 1601-6335
DOI - 10.1111/ocr.12063
Subject(s) - medicine , maxillary hypoplasia , randomized controlled trial , orthognathic surgery , maxilla , distraction osteogenesis , distraction , dentistry , hypoplasia , medline , meta analysis , cinahl , orthodontics , psychological intervention , surgery , psychology , neuroscience , psychiatry , political science , law
Structured Abstract Objective To compare the effectiveness of distraction osteogenesis to orthognathic surgery for the treatment of maxillary hypoplasia in individuals with cleft lip and palate. Method A systematic review of prospective randomized, quasi‐randomized or controlled clinical trials. MEDLINE , EMBASE , Scopus, Web of Science, CINAHL , CENTRAL , trial registers and grey literature were searched. Hand searching of five relevant journals was completed. Two reviewers independently completed inclusion assessment. Data extraction and risk of bias assessment were completed by a single reviewer and checked by a second reviewer. Results Five publications all reporting different outcomes of a single randomized controlled trial are included within the review. The quality of the evidence was low with a high risk of bias. Both surgical interventions produce significant soft tissue improvement. Horizontal relapse of the maxilla was statistically significantly greater following orthognathic surgery. There was no statistically significant difference in speech and velo‐pharyngeal function between the interventions. Maxillary distraction initially lowered social self‐esteem, but this improved with time resulting in higher satisfaction with life in the long term. Conclusions The low quality of evidence included within the review means there is insufficient evidence to conclude whether there is a difference in effectiveness between maxillary distraction and osteotomy for the treatment of cleft‐related maxillary hypoplasia. There is a need for further high‐quality randomized controlled trials to allow conclusive recommendations to be made.