A meta-analysis of cleft maxillary osteotomy and distraction osteogenesis.
This meta-analysis aims to provide evidence-based data to assist surgeons to make an informed choice between distraction osteogenesis or conventional osteotomy for cleft lip and palate patients. A PUBMED search of the National Library of Medicine from 1966 to December 2003 was conducted. Keywords used in the search were 'cleft', 'distraction', 'maxilla', 'maxillary', 'advancement', 'osteotomy', and 'orthognathic surgery'. This study concluded that distraction osteogenesis tends to be preferred to conventional osteotomy for younger CLP patients with more severe deformities. In such cases it was feasible to use distraction to correct moderate to large movement of the maxilla by either complete or incomplete Le Fort I osteotomy, and a concurrent mandibular osteotomy was less frequently required. Intra-operative and post-operative complications were uncommon with either technique, and some of the traditional ischemic complications related to conventional osteotomy were replaced by infection of the oral mucosa due to the prolonged retention of the distractors. There is still no conclusive data on any differences in surgical relapse, velopharyngeal function and speech between the two techniques. Both distraction osteogenesis and conventional osteotomy can deliver a marked improvement in facial aesthetics.
Cheung
L K
LK
Discipline of Oral & Maxillofacial Surgery, Faculty of Dentistry, Prince Philip Dental Hospital, 34 Hospital Road, The University of Hong Kong, Hong Kong SAR, China. lkcheung@hku.hk
Chua
H D P
HD
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000145:classification / Q000601:surgery*; D002972:Cleft Palate / Q000145:classification / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007511:Ischemia / Q000209:etiology; D008297:Male; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000098:blood supply / Q000601:surgery*; D009059:Mouth Diseases / Q000209:etiology; D019857:Osteogenesis, Distraction / Q000295:instrumentation; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D019340:Osteotomy, Le Fort / Q000145:classification; D011183:Postoperative Complications; D012008:Recurrence; D013064:Speech Disorders / Q000503:physiopathology; D013530:Surgical Wound Infection / Q000209:etiology; D014681:Velopharyngeal Insufficiency / Q000503:physiopathology