Cranial Base Angle in Patients With Cleft Lip and Palate—A Systematic Review and Meta-Analysis

Abstract

Background: Diverse findings have been reported for the cranial base angle (CBA) in patients with CLP (cleft lip and palate) and non-CLP controls. Objective: The aim of this study is to assess and evaluate the CBA in patients with CLP and non-CLP controls. Methods: Data from PubMed, OVID Technologies, Inc., Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science, and EMBASE for Excerpta Medica dataBASE (EMBASE) with relevant terms was extracted until December 31, 2020. Inclusion criteria were data of patients with non-syndromic unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). In the case of UCLP and BCLP, patients with craniofacial syndromes were excluded. The study proposal was registered with PROSPERO (Registration number: CRD42021228632). Results: Fifteen studies with a total of 2032 participants were included for the systematic review and 14 studies with a total of 1972 participants were included for the meta-analysis. The risk of bias was assessed using the Modified Newcastle Ottawa scale under seven domains by two authors. Thirteen studies were graded as “good” and two as “satisfactory.” The CBA in patients with CLP were greater than the non CLP Class I controls in six of the 15 studies. CBA was greater in patients with CLP than non-CLP controls by 1.21° (95% CI of 0.19-2.22). Meta-analysis reported considerable heterogeneity (I2 = 86%). Anterior (ACB) and posterior cranial base (PCB) lengths were shorter in patients with CLP than in the non-cleft Class I controls by 2.14 mm (95% CI of 0.99-3.30) and 2.06 mm (95% CI of 1.52-2.60), respectively. Conclusion: Most studies were graded as good. Patients with CLP had greater CBA and shorter ACB and PCB lengths when compared to non-CLP controls.

Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate

“…Similarly, as per AMSTAR 2, 11 were found to be of low quality [ 38 , 42 , 45 , 47 , 50 , 54 , 60 , 61 , 62 , 63 , 65 ] and 26 were graded as critically low [ 21 , 22 , 23 , 24 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 40 , 43 , 44 , 48 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 59 , 64 ] in quality ( Figure 5 ). Furthermore, PRISMA scores showed that 31 SRs had low RE [ 21 , 22 , 23 , 24 , 25 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 45 , 46 , 47 , 48 , …”

“…As per ROBIS-I, high ROB was observed in 33 SRs [ 21 , 22 , 23 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 38 , 40 , 43 , 44 , 45 , 47 , 48 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ] ( Figure 4 ) and low ROB in 13 SRs [ 24 , 29 , 36 , 37 , 39 , 41 , 42 , 46 , 49 , 50 , 57 , 65 , 66 ]. Similarly, as per AMSTAR 2, 11 were found to be of low quality [ 38 , 42 , 45 , 47 , 50 , 54 , 60 , 61 , 62 , 63 ,…”

“…These steps resulted in the inclusion of 18 more SRs. Altogether, 144 SRs and MAs [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , ...…”

“…There was an increasing trend in their numbers with time. The maximum number of published articles were from the year 2021 (n = 29) [ 28 , 46 , 47 , 48 , 55 , 61 , 62 , 63 , 64 , 65 , 69 , 76 , 81 , 82 , 99 , 100 , 101 , 102 , 111 , 128 , 129 , 130 , 142 , 143 , 145 , 148 , 153 , 154 , 161 ]. It was observed that only three studies performed before 2010 could qualify during the two-stage scrutiny [ 72 , 112 , 113 ].…”

“…It was observed that only three studies performed before 2010 could qualify during the two-stage scrutiny [ 72 , 112 , 113 ]. Among the journals, the highest number of papers (n = 30) was published in the Cleft Palate Craniofacial Journal (CPCJ) [ 21 , 35 , 46 , 47 , 48 , 49 , 63 , 65 , 66 , 76 , 86 , 92 , 94 , 100 , 101 , 115 , 116 , 121 , 123 , 125 , 128 , 137 , 140 , 142 , 146 , 150 , 152 , 155 , 161 , 162 ] followed by The Cochrane Library (n = 8) [ 9 , 16 , 68 , 88 , 92 , 93 , 100 , 106 ] and the International Journal of Oral and Maxillofacial Surgery (n = 7) [ 31 , 72 , 89 , 93 , 106 , 110 , 135 ]. There was diversity among the journals of different specialties that had published the SRs related to CLP ( Supplementary Material S4 ).…”

Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate

“…Similarly, as per AMSTAR 2, 11 were found to be of low quality [ 38 , 42 , 45 , 47 , 50 , 54 , 60 , 61 , 62 , 63 , 65 ] and 26 were graded as critically low [ 21 , 22 , 23 , 24 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 40 , 43 , 44 , 48 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 59 , 64 ] in quality ( Figure 5 ). Furthermore, PRISMA scores showed that 31 SRs had low RE [ 21 , 22 , 23 , 24 , 25 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 45 , 46 , 47 , 48 , …”

“…As per ROBIS-I, high ROB was observed in 33 SRs [ 21 , 22 , 23 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 38 , 40 , 43 , 44 , 45 , 47 , 48 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ] ( Figure 4 ) and low ROB in 13 SRs [ 24 , 29 , 36 , 37 , 39 , 41 , 42 , 46 , 49 , 50 , 57 , 65 , 66 ]. Similarly, as per AMSTAR 2, 11 were found to be of low quality [ 38 , 42 , 45 , 47 , 50 , 54 , 60 , 61 , 62 , 63 ,…”

“…These steps resulted in the inclusion of 18 more SRs. Altogether, 144 SRs and MAs [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , ...…”

“…There was an increasing trend in their numbers with time. The maximum number of published articles were from the year 2021 (n = 29) [ 28 , 46 , 47 , 48 , 55 , 61 , 62 , 63 , 64 , 65 , 69 , 76 , 81 , 82 , 99 , 100 , 101 , 102 , 111 , 128 , 129 , 130 , 142 , 143 , 145 , 148 , 153 , 154 , 161 ]. It was observed that only three studies performed before 2010 could qualify during the two-stage scrutiny [ 72 , 112 , 113 ].…”

“…It was observed that only three studies performed before 2010 could qualify during the two-stage scrutiny [ 72 , 112 , 113 ]. Among the journals, the highest number of papers (n = 30) was published in the Cleft Palate Craniofacial Journal (CPCJ) [ 21 , 35 , 46 , 47 , 48 , 49 , 63 , 65 , 66 , 76 , 86 , 92 , 94 , 100 , 101 , 115 , 116 , 121 , 123 , 125 , 128 , 137 , 140 , 142 , 146 , 150 , 152 , 155 , 161 , 162 ] followed by The Cochrane Library (n = 8) [ 9 , 16 , 68 , 88 , 92 , 93 , 100 , 106 ] and the International Journal of Oral and Maxillofacial Surgery (n = 7) [ 31 , 72 , 89 , 93 , 106 , 110 , 135 ]. There was diversity among the journals of different specialties that had published the SRs related to CLP ( Supplementary Material S4 ).…”

Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate

“…Similarly, as per AMSTAR 2, 11 were found to be of low quality [ 38 , 42 , 45 , 47 , 50 , 54 , 60 , 61 , 62 , 63 , 65 ] and 26 were graded as critically low [ 21 , 22 , 23 , 24 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 40 , 43 , 44 , 48 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 59 , 64 ] in quality ( Figure 5 ). Furthermore, PRISMA scores showed that 31 SRs had low RE [ 21 , 22 , 23 , 24 , 25 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 45 , 46 , 47 , 48 , …”

“…As per ROBIS-I, high ROB was observed in 33 SRs [ 21 , 22 , 23 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 38 , 40 , 43 , 44 , 45 , 47 , 48 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ] ( Figure 4 ) and low ROB in 13 SRs [ 24 , 29 , 36 , 37 , 39 , 41 , 42 , 46 , 49 , 50 , 57 , 65 , 66 ]. Similarly, as per AMSTAR 2, 11 were found to be of low quality [ 38 , 42 , 45 , 47 , 50 , 54 , 60 , 61 , 62 , 63 ,…”

“…These steps resulted in the inclusion of 18 more SRs. Altogether, 144 SRs and MAs [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , ...…”

“…There was an increasing trend in their numbers with time. The maximum number of published articles were from the year 2021 (n = 29) [ 28 , 46 , 47 , 48 , 55 , 61 , 62 , 63 , 64 , 65 , 69 , 76 , 81 , 82 , 99 , 100 , 101 , 102 , 111 , 128 , 129 , 130 , 142 , 143 , 145 , 148 , 153 , 154 , 161 ]. It was observed that only three studies performed before 2010 could qualify during the two-stage scrutiny [ 72 , 112 , 113 ].…”

“…It was observed that only three studies performed before 2010 could qualify during the two-stage scrutiny [ 72 , 112 , 113 ]. Among the journals, the highest number of papers (n = 30) was published in the Cleft Palate Craniofacial Journal (CPCJ) [ 21 , 35 , 46 , 47 , 48 , 49 , 63 , 65 , 66 , 76 , 86 , 92 , 94 , 100 , 101 , 115 , 116 , 121 , 123 , 125 , 128 , 137 , 140 , 142 , 146 , 150 , 152 , 155 , 161 , 162 ] followed by The Cochrane Library (n = 8) [ 9 , 16 , 68 , 88 , 92 , 93 , 100 , 106 ] and the International Journal of Oral and Maxillofacial Surgery (n = 7) [ 31 , 72 , 89 , 93 , 106 , 110 , 135 ]. There was diversity among the journals of different specialties that had published the SRs related to CLP ( Supplementary Material S4 ).…”

Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate

“…Similarly, as per AMSTAR 2, 11 were found to be of low quality [ 38 , 42 , 45 , 47 , 50 , 54 , 60 , 61 , 62 , 63 , 65 ] and 26 were graded as critically low [ 21 , 22 , 23 , 24 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 40 , 43 , 44 , 48 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 59 , 64 ] in quality ( Figure 5 ). Furthermore, PRISMA scores showed that 31 SRs had low RE [ 21 , 22 , 23 , 24 , 25 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 45 , 46 , 47 , 48 , …”

“…As per ROBIS-I, high ROB was observed in 33 SRs [ 21 , 22 , 23 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 38 , 40 , 43 , 44 , 45 , 47 , 48 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ] ( Figure 4 ) and low ROB in 13 SRs [ 24 , 29 , 36 , 37 , 39 , 41 , 42 , 46 , 49 , 50 , 57 , 65 , 66 ]. Similarly, as per AMSTAR 2, 11 were found to be of low quality [ 38 , 42 , 45 , 47 , 50 , 54 , 60 , 61 , 62 , 63 ,…”

“…These steps resulted in the inclusion of 18 more SRs. Altogether, 144 SRs and MAs [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , ...…”

“…There was an increasing trend in their numbers with time. The maximum number of published articles were from the year 2021 (n = 29) [ 28 , 46 , 47 , 48 , 55 , 61 , 62 , 63 , 64 , 65 , 69 , 76 , 81 , 82 , 99 , 100 , 101 , 102 , 111 , 128 , 129 , 130 , 142 , 143 , 145 , 148 , 153 , 154 , 161 ]. It was observed that only three studies performed before 2010 could qualify during the two-stage scrutiny [ 72 , 112 , 113 ].…”

“…It was observed that only three studies performed before 2010 could qualify during the two-stage scrutiny [ 72 , 112 , 113 ]. Among the journals, the highest number of papers (n = 30) was published in the Cleft Palate Craniofacial Journal (CPCJ) [ 21 , 35 , 46 , 47 , 48 , 49 , 63 , 65 , 66 , 76 , 86 , 92 , 94 , 100 , 101 , 115 , 116 , 121 , 123 , 125 , 128 , 137 , 140 , 142 , 146 , 150 , 152 , 155 , 161 , 162 ] followed by The Cochrane Library (n = 8) [ 9 , 16 , 68 , 88 , 92 , 93 , 100 , 106 ] and the International Journal of Oral and Maxillofacial Surgery (n = 7) [ 31 , 72 , 89 , 93 , 106 , 110 , 135 ]. There was diversity among the journals of different specialties that had published the SRs related to CLP ( Supplementary Material S4 ).…”