Outcomes of Maxillary Orthognathic Surgery in Patients with Cleft Lip and Palate: A Literature Review
- 141 Downloads
Cleft lip and palate (CLP) patients often require orthognathic surgical correction due to maxillary hypoplasia secondary to primary surgeries, through either distraction osteogenesis (DO) or conventional orthognathic surgery (CO). The objective was to evaluate both surgical techniques regarding functional, aesthetics and quality-of-life and stability outcomes for the patient.
Materials and Method
The PubMed database was searched with the inclusion criteria: studies in English detailing maxillary orthognathic surgery on non-syndromic patients with CLP. Clinical trials, systematic reviews, meta-analysis, reviews, randomized control trials were included. Studies with less than five patients and studies reporting bimaxillary surgery were excluded. References lists of these studies were consulted for more studies to be included. Studies were then evaluated for relevance, quality checked for risk of bias and divided based on the results studied. In total, 22 studies published between 1997 and 2017 were included.
Most studies had low levels of bias. The evidence to support one surgical technique before the other was low. DO offered better stability. No clear evidence exists on which technique had the best aesthetic results and functional improvement. DO may cause higher levels of anxiety and distress in patients compared to CO.
Regarding all outcomes studied, the scrutinized literature did not allow for the recommendation of one specific technique. Future multicentre collaboration may enable greater sample size and better statistical comparison of results of both techniques.
KeywordsCleft lip and palate Le Fort I osteotomy Distraction osteogenesis Conventional orthognathic surgery Review
Compliance with Ethical Standards
Conflict of interest
All authors declare that they have no conflict of interest.
- 1.Moore UJ (2011) Principles of oral and maxillofacial surgery, 6th edn. Wiley, ChichesterGoogle Scholar
- 2.Beumer J III, Marunick MT, Esposito SJ (2011) Maxillofacial rehabilitation: prosthodontic and surgical management of cancer-related, acquired, and congenital defects of the head and neck, 3rd edn. Quintessence Pub, Hanover ParkGoogle Scholar
- 4.Shprintzen RJ, Bardach J (1995) Cleft palate speech management a multidisciplinary approach, 1st edn. Mosby, St LouisGoogle Scholar
- 5.Hupp JR, Tucker MR, Ellis E III et al (2014) Contemporary oral and maxillofacial surgery, 6th edn. Mosby, St LouisGoogle Scholar
- 6.Shah A, Danahey D (2016) Distraction osteogenesis of the maxilla treatment & management. Medscape. https://emedicine.medscape.com/article/844742-treatment Accessed 9 Feb 2018
- 8.Defrancq J Orthognathic classification—facial balance. Dr Joel Defrancq Join. Worlds Funct. Aesthet. https://www.facialsculptureclinic.com/en/surgery/orthognathic-classification/facial-balance/. Accessed 9 Feb 2018
- 13.Figueroa AA, Polley JW (1999) Management of severe cleft maxillary deficiency with distraction osteogenesis: procedure and results. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod 115:1–12Google Scholar
- 17.McCance AM, Moss JP, Fright WR et al (1997) Three-dimensional analysis techniques–Part 4: three-dimensional analysis of bone and soft tissue to bone ratio of movements in 24 cleft palate patients following Le Fort I osteotomy: a preliminary report. Cleft Palate Craniofac J 34:58–62CrossRefPubMedGoogle Scholar