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Meta-Analysis
. 2022 Jan 25;44(1):22-29.
doi: 10.1093/ejo/cjab017.

Comparison of long-term skeletal stability following maxillary advancement using rigid external distraction in growing and non-growing patients with cleft lip and palate: a systematic review and meta-analysis

Kunal Ashok Nimbalkar  1 , Sanjeev Datana  1 , Shiv Shankar Agarwal  1 , Sukhbir Singh Chopra  1 , Sujit Kumar Bhandari  2
Affiliations
Meta-Analysis

Comparison of long-term skeletal stability following maxillary advancement using rigid external distraction in growing and non-growing patients with cleft lip and palate: a systematic review and meta-analysis

Kunal Ashok Nimbalkar et al. Eur J Orthod. .

Abstract

Objectives: To compare the long-term skeletal stability following maxillary advancement using Rigid External Distraction (RED) in growing and non-growing patients with Cleft Lip and Palate (CLP).

Methods: Data sources: A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from database inception till August 2020 in MEDLINE-PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar and a manual search in the institutional library. Study eligibility criteria, participants and intervention: All available literature published in English, with a minimum of six human subjects with well-defined age range either 7-14.9 years or 15-30 years, follow up period of a minimum of 12 months assessing the skeletal stability as horizontal change at Point A (Subspinale) following maxillary advancement using a RED device, without the use of rigid internal fixation or bone grafts were included in the study. Study appraisal and synthesis method: The quality assessment of selected articles was done using the Newcastle-Ottawa scale. The meta-analysis was carried out with Q statistic method, I-squared statistics, fixed-effect model to estimate pooled mean and Begg-Mazumdar bias indicator.

Results: Selected nine articles that were qualitatively assessed for relapse rate following maxillary advancement using a RED device, showed consistent and stable results. The meta-analysis found no significant difference in long-term skeletal stability of maxillary advancement by RED device in growing and non-growing patients with CLP [(growing group: Pooled proportion = 0.2927; 95% CI = 0.1534 to 0.4319) (non-growing group: Pooled proportion = 0.23077; 95% CI = 0.09854 to 0.36300)].

Limitations: No study, as revealed by the search, was available that compared the two groups as defined by the inclusion criteria. Data for the two groups were retrieved from different studies and meta-analysed.

Conclusion: RED is an effective modality for correction of maxillary hypoplasia secondary to CLP, requiring large maxillary advancement. The technique can be used in young and adult patients with similar long-term results.

Prospero registration number: CRD42020205513.

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