Introduction
Materials and methods
Search protocol and selection of articles
Search and selection
Database | Terms |
---|---|
PubMed | ((((((((((((((“bilateral alveolar cleft” [Title/Abstract]) OR “bilateral alveolar clefts” [Title/Abstract]) OR “secondary alveolar bone grafting” [Title/Abstract]) OR “blcp” [Title/Abstract]) OR “alveolar cleft” [Title/Abstract]) OR “alveolar clefts” [Title/Abstract]) OR “premaxilla” [Title/Abstract]) OR “premaxillary” [Title/Abstract]) OR “bilateral cleft” [Title/Abstract]) OR “bilateral cleft alveolus” [Title/Abstract]) OR “bilateral cleft lip/cleft palate” [Title/Abstract]) OR “intermaxillare” [Title/Abstract]) OR ((“Cleft Palate/surgery” [Mesh] OR “Cleft Palate/therapy” [Mesh])))) |
AND | |
((((((((((((((((((surgery[Title/Abstract]) OR “surgical” [Title/Abstract]) OR “surgeries” [Title/Abstract]) OR “operation” [Title/Abstract]) OR “operated” [Title/Abstract]) OR “operate” [Title/Abstract]) OR “reposition” [Title/Abstract]) OR “repositioning” [Title/Abstract]) OR “repositioned” [Title/Abstract]) OR “graft” [Title/Abstract]) OR “grafted”) OR “grafting” [Title/Abstract]) OR “surgically” [Title/Abstract]) OR “orthodontic” [Title/Abstract]) OR “orthodontically” [Title/Abstract]) OR “orthodontics” [Title/Abstract]) OR “orthopedics” [Title/Abstract]) OR “orthopedic” [Title/Abstract]) | |
EMBASE | (‘bilateral alveolar cleft’:ab,ti OR ‘bilateral alveolar clefts’:ab,ti OR ‘secondary alveolar bone grafting’:ab,ti OR bclp:ab,ti OR ‘alveolar cleft’:ab,ti OR ‘alveolar clefts’:ab,ti OR premaxilla:ab,ti OR premaxillary:ab,ti OR ‘bilateral cleft’:ab,ti OR ‘bilateral cleft alveolus’:ab,ti OR ‘bilateral lip cleft palate’:ab,ti OR intermaxillare:ab,ti OR ‘cleft palate’/exp) |
AND | |
(surgery:ab,ti OR surgical:ab,ti OR surgeries:ab,ti OR operation:ab,ti OR operated:ab,ti OR operate:ab,ti OR reposition:ab,ti OR repositioning:ab,ti OR repositioned:ab,ti OR graft:ab,ti OR grafted:ab,ti OR grafting:ab,ti OR surgically:ab,ti OR surgically:ab,ti OR orthodontic:ab,ti OR orthodontically:ab,ti OR orthodontics:ab,ti OR orthopedics:ab,ti OR orthopedic:ab,ti) AND [embase]/lim NOT[medline]/lim | |
Cochrane | Cleft palate mesh |
Results
Author (reference) | Patients cases | Intervention | Follow-up | Premaxilla position | Other |
---|---|---|---|---|---|
Scott [1] | 15 Retrospective follow-ups | Secondary alveolar bone grafting + osteotomy | 3 Years | – | 93.96 % of bone height is retained after 3 months |
Geraedts [2] | 40 Retrospective follow-ups | Early secondary alveolar bone grafting + osteotomy | 8 Years | At age 17, 13 patients needed osteotomy | Cephalometric analysis |
Le Fort needed in nine patients | |||||
Brouns [3] | 31 Retrospective follow-ups | Osteotomy + bone graft, sometimes second operation | 1 Year | Angle class I/II group, 17 patients good occlusion | Bigger position corrections result in bigger chance of complications |
Angle class III group, 13 patients good occlusion | |||||
Angle class IV group, one patient good occlusion | |||||
Carlini [4] | 50 Retrospective follow-ups | Secondary alveolar bone grafting + osteotomy | 1 Year | – | – |
Freihofer [5] | 13 Retrospective follow-ups | Secondary alveolar bone grafting + osteotomy | 15 months | – | Residual bone height in 15 patients more than 50 % |
Heidbuchel [6] | 22 Retrospective follow-ups | Secondary alveolar bone grafting + osteotomy | 7 Years | SNA average increase 2.02° | 18 Patients more than 50 % maxilla height. |
3.34° reduction of angle between spinal plane and SN plane | Cephalometric analysis | ||||
Grabowski [7] | 18 Follow-ups | Orthopaedics and orthodontics (osteoplasty) | 17.3 Years | Nine patients, SOB >2 mm, VOB >2 mm | Cephalometric results |
Criteria: time of treatment, type of orthodontic treatment, method of closing the incisor gap in the cleft area, special methods. | |||||
Seven patients, SOB >3 mm | |||||
VOB >3 mm | |||||
Cronin [8] | 5 Case studies | Osteotomy and Kirschner wire fixation | – | – | – |
Liou [9] | 8 Prospective follow-ups | Tooth-borne distraction device | 1 Year | Before treatment, SOB average 8.4 mm, VOB 3.7 mm | 46 % true orthopaedic intrusion of the premaxilla, 54 % dental intrusion of the premaxilla |
After treatment, SOB 0.7 mm | |||||
Padwa [10] | 24 Non-randomised controlled trials | Early vs. late vs. no osteotomy of the premaxilla | 2.8–5.7 Years | – | Cephalometric results |
Akita [11] | 17 Non-randomised controlled trials | Osteotomy of the premaxilla with secondary alveolar bone grafting vs. secondary alveolar bone grafting alone | 0.5–3 years | – | 0–25 % bone resorption in the osteotomised group in 12/14 clefts. |
0–25 % bone resorption in the non-osteotomised group in 10/20 clefts | |||||
Bishara [12] | 20 Retrospective follow-up controlled studies | Premaxilla osteotomy at time of lip closure vs. two-staged closure of the lip and no osteotomy | 17 years | – | Cephalometric analysis |
Koh [13] | 8 Retrospective case studies | Interdental distraction osteogenesis, alveolar bone grafting, premaxilla osteotomy | 56 months | – | Bone height, 98 % of patients between 50 and 100 % left |
Aburezq [14] | 4 Retrospective follow-ups | Secondary alveolar bone grafting + osteotomy | 10 months | – | Two patient → grade 1 |
One patient → grade 2 | |||||
One patient → grade 3 | |||||
Oyama [15] | 6 Case studies | Secondary alveolar bone grafting + osteotomy | 3 months | – | Bone height is good |
Narayanan [16] | 14 Case studies | Palatal repair and premaxilla setback | 6 months | 10–15 mm setback. Five had class III relationship. Two had open bite | Good results |
Article | Outcome parameter | Comment |
---|---|---|
Timing and technique of premaxillary correction | ||
Grabowski et al. (2006) | Orthopaedic and orthodontic treatment starting at an early age: | |
N = 18 Good results no osteotomy required. | ||
Two patients with crossbite | ||
Class III in three patients | ||
Liou et al. (2004) | Orthopaedic and orthodontic treatment between 8 and 11 years: | |
N = 8 correction of the premaxilla using a distractor | ||
Overbite reduction to 0.7 mm | ||
Cronin et al. (1957) | Surgery during neonatal period | Bad outcome for maxillary growth |
Bishara et al. (1972) | Osteotomy during neonatal period, compared with no osteotomy: | Early osteotomy has a bad outcome on maxillary growth |
SNA significantly smaller in osteotomy group. | ||
SNB negative | ||
Concave soft tissue profile | ||
Heidbüchel et al. (1993) | Orthodontics and osteotomy: | After osteotomy, better inclination of maxillary incisors |
N = 22 prior to surgery orthodontic intrusion of the premaxilla. After osteotomy, SNA decreased by 2.02 | ||
Scott et al. (2007) | Age 8–12 years, good results surgical correction of the premaxilla. | Collagen membrane was used to close the nasal mucosal layer |
Koh et al. (2013) |
N = 51, 36 patients treated with bone grafting only. | |
N = 7 wide cleft, good premaxillary position. Treated with a distractor | ||
N = 8 surgical repositioning of premaxilla. | ||
Brouns et al. (1980) |
N = 31 surgical repositioning of premaxilla | |
In the Angle class I and II groups, good occlusion | ||
In the Angle class III group, good occlusion | ||
In the class IV group, good occlusion | ||
Akita et al. (2006) |
N = 17 divided into two groups | |
N = 10 no premaxillary osteotomy | ||
N = 7 premaxillary osteotomy | ||
Aburezq et al. (2006) |
N = 4 osteotomy combined with secondary alveolar bone grafting. | |
Freihofer et al. (1991) |
N = 13 surgical repositioning of the premaxilla between 8 and 12 years | |
N = 8 preoperative orthodontics | ||
N = 10 postoperative orthodontics | ||
Geraedts et al. (2007) |
N = 40 combination of pre-orthodontic treatment and repositioning of the premaxilla between 8 and 12 years | |
Narayanan et al. (2006) | Tertiary osteotomy in children in developing countries. | Children were not operated on until the tertiary osteotomy |
Stability of the position of the premaxilla and bone volume | ||
Scott et al. (2007) |
N = 15 iliac crest bone transplants, all successful | |
93.96 % bone volume preserved after 3 months | ||
Koh et al. (2013) | In 96.1 % of patients, more than 50 % transplant bone volume was preserved | |
Brouns et al. (Brouns & Egyedi, (1980) | Of the Angle class I and II patients N = 17, N = 11, consolidation no premaxillary instability | |
Angle class III group N = 13, N = 11 good consolidation | ||
N = 2 remaining unstable premaxilla | ||
Class IV N = 1 group stable premaxilla | ||
Carlini et al. (2009) |
N = 50, 45 patients no mobility of the premaxilla. | |
Akita et al. (2006) | The amount of bone required to fill the cleft was significantly lower in the osteotomy group. | |
Aburezq et al. (2006) |
N = 3 with good consolidation and more than 50 % bone volume left. | After trauma |
N = 1 unstable premaxilla | ||
Freihofer et al. (1991) |
N = 9 rib bone | |
N = 3 mandibular bone | ||
N = 1 local bone | ||
N = 12 premaxilla stable and more than 50 % of bone preserved | ||
Narayanan et al. (2006) | Uninhibited growth up to time of surgery on the premaxilla. | |
Effects of surgery or orthodontic intervention on maxillary growth | ||
Cronin et al. (1957) | Surgery during neonatal period with disastrous effect on growth | |
Bishara et al. (1972) | Surgery during neonatal period with bad effect on maxillary growth | |
Geraedts et al. (2007) |
N = 27 acceptable profile at the end of follow-up | |
N = 13 hypoplastic midface for which a Le Fort I procedure was carried out | ||
No significant differences between osteotomy and non-osteotomy groups | ||
Padwa et al. (1991) |
N = 24 comparing three groups, for the effect of age on midfacial growth at time of surgery. Youngest group 6 years old. | |
No delay in midfacial growth in any of the groups. | ||
Complications reported in the literature | ||
Heidbüchel et al. (1993) | Premaxillary necrosis in one patient (5 %) | |
Scott et al. (2007) |
N = 15, three patients with wound dehiscence | |
Brouns et al. (1980) | In the class III group, 11 patients with residual fistula, no necrosis of the premaxilla | |
Carlini et al. (2009) |
N = 50 successful premaxilla repositioning and bone grafting in 48 patients. Two patients with premaxillary necrosis. | |
Aburezq et al. (2006) | No necrosis of the premaxilla. One patient with residual fistula | |
Freihofer et al. (1991) |
N = 1 necrosis of the bone transplants on both sides | |
Geraedts et al. (2007) |
N = 1 recurrent oronasal fistula |
Early non-surgical correction during the first year of life and <8 years
Early primary surgical correction <8 years
Early and late secondary combined treatment (between 8 and 12 years)
Late surgical correction (tertiary >12 years)
The position of the premaxilla and the results of bone grafting
Article | Number of patients | Complications described in article | Type bone graft (N) | Complication (N) | Patients with stable premaxilla | Less than 50 % bone graft resorption |
---|---|---|---|---|---|---|
Scott et al. (2007) | 15 | 15 | Iliac crest (15) | Wound dehiscence (3) | 12 | 15 |
Brouns et al. (1980) | 31 | 31 | Iliac crest (31) | No consolidation (9) | 22 | 22 |
Carlini et al. (2009) | 50 | 50 | Iliac crest (26)/mandibular symphysis (24) | Bone loss (3)/premaxillary necrosis (2) | 45 | 45 |
Freihofer et al. (1991) | 13 | 13 | Rib bone (9)/mandibular symphysis (3)/other (1) | Premaxillary necrosis (1) | 12 | 12 |
Cronin et al. (1957) | 40 | – | – | – | – | – |
Heidbuchel et al. (1993) | 22 | 1 | Rib (11)/iliac crest (5)/mandibular symphysis (4)/maxillary (1)/bank bone (1) | Premaxillary necrosis (1) | – | 18 |
Padwa et al. (1999) | 17 | – | – | – | – | – |
Akita et al. (2006) | 7 | 7 | Mandibular symphysis (7) | Bone loss (1) | 6 | 6 |
Bishara et al. (1972) | 20 | – | – | – | – | – |
Aburezq et al. (2006) | 4 | 4 | Iliac crest(4) | Bone loss (1) | 3 | 3 |
Geraedts et al. (2007) | 40 | – | – | – | – | – |
Total | 259 | 121 | 142 | 20 | 100 | 121 |