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Distraction osteogenesis versus orthognathic surgery for the treatment of maxillary hypoplasia in cleft lip and palate patients: a systematic review

Lookup NU author(s): Dr Clare Mattick, Professor Paula WaterhouseORCiD

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Abstract

ObjectiveTo compare the effectiveness of distraction osteogenesis to orthognathic surgery for the treatment of maxillary hypoplasia in individuals with cleft lip and palate.MethodA 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.ResultsFive 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.ConclusionsThe 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.

Publication metadata

Author(s): Austin SL, Mattick CR, Waterhouse PJ

Publication type: Article

Publication status: Published

Journal: Orthodontics & Craniofacial Research

Year: 2015

Volume: 18

Issue: 2

Pages: 96-108

Print publication date: 01/05/2015

Online publication date: 29/12/2014

Acceptance date: 23/11/2014

ISSN (print): 1601-6335

ISSN (electronic): 1601-6343

Publisher: Wiley-Blackwell

URL: http://dx.doi.org/10.1111/ocr.12063

DOI: 10.1111/ocr.12063

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