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Meta-Analysis
. 2024 Nov 19;24(1):1409.
doi: 10.1186/s12903-024-05208-3.

Efficacy of the maxillary anterior segmental distraction osteogenesis in patients with cleft lip and palate

Panjun Pu #  1   2 , Shanying Bao #  3 , Jianbo Gao #  4 , Yuhua Jiao  1   2 , Feiyu Wang  1   2 , Huaxiang Zhao  1   2 , Yuxia Hou  1   2 , Yalin Zhan  5
Affiliations
Meta-Analysis

Efficacy of the maxillary anterior segmental distraction osteogenesis in patients with cleft lip and palate

Panjun Pu et al. BMC Oral Health. .

Abstract

Background: Cleft lip and palate (CLP) is one of the most common birth defects worldwide. It typically results in significant maxillary dysplasia, causing severe oral function problems and substantially affecting the patient's facial aesthetics. Maxillary anterior segmental distraction osteogenesis (MASDO) has gained popularity in recent years as an effective treatment for correcting maxillary dysplasia. However, the evaluation of its effectiveness in patients with CLP varies across different studies. Our research was aimed at providing evidence of the effects of MASDO among CLP patients.

Methods: A meta-analysis covered Medline, Web of Science, Embase, Scopus, and Cochrane Library. Controlled clinical trial studies published before February 2024 and analyzed changes in maxillary cephalometric landmarks before and after MASDO among patients with maxillary hypoplasia and CLP were included.

Results: Our meta-analysis included 10 papers in total. One study was at low risk of bias, seven were at medium risk, and two were at serious risk. MASDO significantly increased the maxillary length. The mean SNA angle increased by 6.43° (95% CI, 4.11° to 8.74°) and A-McNamara rose by 7.29 mm (95% CI, 6.21 mm to 8.37 mm). The maxilla also showed a slight counterclockwise rotation; however, this reached no statistical significance. The mandibular position did not vary remarkably. Moreover, a significant increase in upper anterior tooth tipping and overjet, a decrease in overbite, and an improvement in nasolabial soft tissue were observed.

Conclusions: MASDO might be a valid therapy option for CLP patients. It causes a significant increase in the maxillary length, anterior tooth crossbite, and nasolabial soft tissue were also greatly improved.

Keywords: Cleft lip and palate; Maxillary hypoplasia; Meta-analysis; Systematic review.

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Conflict of interest statement

Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The clinical diagrams for the procedure of MASDO. (a) The palatal distractor was positioned on the palate and osteotomy was made between the maxillary first molar and the second premolar; (b) Linear advancement of the anterior part of the maxilla was achieved by activating the distractor positioned on the palate
Fig. 2
Fig. 2
The PRISMA flow chart of the research selection
Fig. 3
Fig. 3
The risk of bias evaluation in the individual researches with the ROBINS-I instrument
Fig. 4
Fig. 4
Forest plot of maxilla sagittal change after MASDO. The outcomes were assessed: (a) SNA (°) increase after MASDO; (b) A-McNamara (mm) increase after MASDO; (c) ANS-PNS (mm) increase after MASDO;
Fig. 5
Fig. 5
Forest plot of maxilla vertical change after MASDO. The outcomes were assessed: (a) FH-ANS (mm) increase after MASDO; (b) FH-A (mm) increase after MASDO; (c) SN-PP (°) increase after MASDO
Fig. 6
Fig. 6
Forest plot of SNB (°) and ANB (°) change after MASDO
Fig. 7
Fig. 7
Forest plot of tooth and nasolabial soft tissue change after MASDO. The outcomes were assessed: (a) Overjet (mm) increase after MASDO; (b) U1/SN (°) increase after MASDO; (c) Overbite (mm) increase after MASDO; (d) Nasolabial angle (°) increase after MASDO; (e) Upper lip to E-line (mm) increase after MASDO
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