Effectiveness of Gingivoperiosteoplasty on Alveolar Bone Reconstruction and Facial Growth in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis

Abstract

Objective: The aim of the systematic review is to evaluate the effects of gingivoperiosteoplasty (GPP) on alveolar bone quality and facial growth in patients with cleft lip and palate (CLP). Search Methods: Electronic and manual search was done up to October 2017. Eligibility Criteria: Clinical and observational studies that compared GPP to control; patients without GPP evaluated either before or after the age for secondary bone graft (SBG). Data Collection and Analysis: Studies selection was done by 2 authors independently. Risk ratio and mean difference with 95% confidence intervals (CIs) were calculated using random-effects models. Results: Thirteen articles were included in the review. All studies were at high risk of bias. Poorer alveolar bone quality was found in the GPP group compared to the SBG group. The pooled data showed a statistically significant increase in the incidence of Bergland type III in the GPP group compared to SBG (risk ratio: 11.51, 95% CI: 3.39-35.15). As for facial growth, GPP group resulted in a more retruded maxillary position (as indicated by “Sella-Nasion-Subspinale” angle [SNA value]) compared to control group by −1.36 (CI: −4.21 to 1.49) and −1.66 (CI: −2.48 to −0.84) when evaluated at 5 and 10 years, respectively. The protocol for presurgical infant orthopedics used in conjunction with the GPP procedure might have affected the results of the alveolar bone and facial growth outcomes. Conclusions: Definitive conclusions about the effectiveness of GPP cannot be drawn. Very weak evidence indicated that GPP might not be an efficient method for alveolar bone reconstruction for patients with unilateral and bilateral CLP. Gingivoperiosteoplasty surgery could lead to maxillary growth inhibition in patients with CLP.

Evolving Trends in Unilateral Cleft Lip Repair Based on Continuous Certification by the American Board of Plastic Surgery

“…Additionally, it may inhibit maxillary growth in patients with cleft lip and palate. 30 Tracer: There was a significant drop in the rate of GPP when comparing the data up until 2016 (9%) to 2017-2020 (1%; P < 0.001) (Supplementary Digital Content, Table 2, http:// links.lww.com/SCS/D42).…”

Tessier 30 Facial Clefts—A Literature Review of 72 Cases (1996-2020), Suggested Treatment Protocol, Outcome Measures, Minimum Dataset for Future Case Reports, and Registries

“…It may reduce the need for further bone graft in terms of volume of bone, or indeed, no further grafting may be required. Growth will need to be monitored and we note concerns authors have had with regard to this procedure in the maxilla in alveolar cleft management (El-Ashmawi et al, 2019), but infantile mandibular growth may not be affected in the same way. Cellulose dressings may act as a supportive network for clot and callus formation.…”

“…Such defects can vary widely in their extent and severity: they can be associated with a midline lower lip cleft, a cleft of the mandibular symphysis, a bifid tongue, ankyloglossia and in some cases can continue to the manubrium sterni and involve the hyoid bone, thyroid cartilage, and strap muscles of the neck (Walker et al, 2019a(Walker et al, , 2019b. These clefts are often associated with dental anomalies, soft tissue skin tags and can be markedly asymmetrical (El-Ashmawi et al, 2019). They are reported to be as rare as 4 to 5 per million live births (Becker, 1986).…”

Evaluation of Bone Regeneration in Single Stage Closure of Cleft Alveolus with Gingivoperiosteoplasty

“…Conventionally, a primary GPP or primary alveolar bone grafting is performed at the stage of lip repair or soon after, when the patient is less than 2.5 years old. Secondary GPP or secondary grafting commonly refers to surgical alveolar reconstruction (by soft tissue bridging or alveolar bone, respectively) performed post lip repair (between 2.5 and 10 years) [4]. Surgical correction of cleft lip and palate remains a solitary problem, principally because the fundamental surgical problem is not clearly conceptualized.…”

“…In Skoog's method, the lack of presurgical orthopedics (PSIOs) involved extensive subperiosteal maxillary dissection to close the alveolar cleft. However, the invention of PSIOs led to the development of less invasive GPP surgery (Millard-type GPP) [4].…”