Relapse rate after surgical treatment of maxillary hypoplasia in non-growing cleft patients: a systematic review and meta-analysis

Abstract

Maxillary hypoplasia in cleft lip and palate is a complex deformity. Despite surgical improvements, postoperative relapse persists. This systematic review was performed to determine the mean horizontal relapse rates for the surgical techniques used to treat maxillary hypoplasia: Le Fort I osteotomy with rigid fixation, Le Fort I distraction osteogenesis, and anterior maxillary distraction osteogenesis. This study followed the PRISMA statement. The PubMed, Embase, Science Direct, and Web of Science databases were searched through to June 2018. Studies on non-growing cleft lip and palate patients who had undergone one of the three surgical procedures and who had postoperative horizontal maxillary changes assessed at >6 months post-surgery were included. Stata SE was used to estimate pooled means, heterogeneity, and publication bias. The search strategy identified 326 citations, from which 24 studies were selected. Relapse rates following Le Fort I osteotomy with rigid fixation, Le Fort I distraction osteogenesis, and anterior maxillary distraction osteogenesis were 20%, 12%, and 12%, respectively. Relapse rates with and without bone grafting were 19% and 66%, respectively. The relapse rate following distraction osteogenesis with internal distraction was lower than that with external distraction. Study limitations were heterogeneity, which was above moderate, the low number of high-quality studies, and unidirectional assessment of postoperative maxillary movement.

Surgery-first orthognathic approach for correction of dentofacial deformity in unilateral cleft lip and palate

“…32,33 However, instability immediately after surgery in the surgery-first approach continues to be a concern of clinicians because the surgical occlusion is relatively unstable without presurgical orthodontics. Our findings showed maxillary advancement and clockwise pitch rotation was stable in the sagittal, vertical, and transverse directions (<1 mm) with an 11% sagittal relapse rate (changes posttreatment compared with after surgery), which is lower than the rate of 20% reported in a recent meta-analysis by Jiang et al, 34 and most likely a consequence of stretching of the palatal mucosa before fixation. The mandibular setback was relatively stable in the sagittal and transverse directions with a 30% (<2 mm) sagittal relapse rate.…”

Skeletal Stability of Two-Jaw Surgery Without Bone Grafting in Patients With Cleft Lip and Palate

“…The second factor concerns whether to perform interpositional bone graft on the bony gap caused by maxillary advancement. Horizontal relapse rates of maxillary advancement have been reported to be between 23% and 36% with a bone graft 11,17–20 . Gomes et al 6 studied the effect of an allogeneic bone graft on postoperative stability after Le Fort I osteotomy in cleft patients.…”

“…Horizontal relapse rates of maxillary advancement have been reported to be between 23% and 36% with a bone graft. 11,[17][18][19][20] Gomes et al 6 studied the effect of an allogeneic bone graft on postoperative stability after Le Fort I osteotomy in cleft patients. The results showed that horizontal relapse was reduced in bone graft cases but that vertical relapse was unaffected.…”

Accuracy of virtually planned maxillary distraction in cleft patients - An evaluative study

“…[ 2 ] Recently, Jiang et al 's meta-analysis found a lower relapse rate following DO with internal distractors than with external distractors. [ 18 ]…”