Bichara L M, Araújo R C, Flores-Mir C, Normando D
Orthodontics Department, Federal University of the State of Pará, Belém, Pará, Brazil.
School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Int J Oral Maxillofac Surg. 2015 Jan;44(1):50-6. doi: 10.1016/j.ijom.2014.08.004. Epub 2014 Sep 10.
The study objective was to evaluate, through a meta-analysis, the impact of primary palatoplasty on the sagittal maxillary and mandibular relationship among patients with complete unilateral cleft lip and palate (UCLP). Electronic database and hand searches were performed. Controlled clinical trials involving non-syndromic UCLP patients were included. Selected papers had to include a group of patients undergoing lip and palate repair and a group undergoing lip repair only. Data heterogeneity was demonstrated and individual means, standard deviations, and sample sizes were collected and summarized using a random effects model meta-analysis. Although six articles were selected for the systematic review, only four were included in the meta-analysis due to large discrepancies in the standard surgical protocol. Only one variable assessing the intermaxillary relationship (A point-nasion-B point; ANB), maxillary position (sella-nasion-A point; SNA), and mandibular position (sella-nasion-B point; SNB) was common among the selected studies. No significant differences in SNA and SNB were indentified between patients undergoing lip surgery alone and those undergoing lip and palate surgery. Evaluation of ANB showed a small statistical standard mean difference of 0.36°. Impaired maxillary sagittal growth, observed in patients with UCLP, appears to be a basic consequence of lip surgical repair. Additional changes to the maxilla and mandible produced by palatal repair are minor. Methodologically rigorous controlled studies are needed to provide a stronger evidence-based basis for the surgical management of patients with UCLP.
本研究的目的是通过荟萃分析评估一期腭裂修复术对完全性单侧唇腭裂（UCLP）患者上颌骨和下颌骨矢状关系的影响。进行了电子数据库检索和手工检索。纳入了涉及非综合征性UCLP患者的对照临床试验。入选论文必须包括一组接受唇腭裂修复的患者和一组仅接受唇修复的患者。证实了数据的异质性，并使用随机效应模型荟萃分析收集和汇总了个体均值、标准差和样本量。尽管为系统评价选择了6篇文章，但由于标准手术方案存在较大差异，荟萃分析中仅纳入了4篇。在所选研究中，只有一个评估颌间关系（A点-鼻根点-B点；ANB）、上颌位置（蝶鞍-鼻根点-A点；SNA）和下颌位置（蝶鞍-鼻根点-B点；SNB）的变量是常见的。单独接受唇手术的患者与接受唇腭裂手术的患者之间，未发现SNA和SNB有显著差异。对ANB的评估显示，统计学标准平均差异较小，为0.36°。在UCLP患者中观察到的上颌矢状生长受损似乎是唇手术修复的一个基本后果。腭裂修复对上颌骨和下颌骨产生的额外变化较小。需要进行方法学上严格的对照研究，为UCLP患者的手术治疗提供更有力的循证依据。
