Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain; Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain.
Fellow, Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain.
J Craniomaxillofac Surg. 2021 Oct;49(10):879-890. doi: 10.1016/j.jcms.2021.09.002. Epub 2021 Sep 10.
A systematic review search was based on the PICOS approach, as follows: population: cleft lip and palate patients; intervention: Le Fort I osteotomy; comparator: different surgical protocols; outcome: stability, recurrence or surgical complications; study designs: only case reports were excluded from the review. No restrictions were placed on language or year of publication. Risk of bias was analyzed, heterogeneity was assessed, and subgroup analysis was performed using a level of significance of 1% (p = 0.01). The search identified 248 citations, from which 29 studies were selected and a total of 797 patients enrolled. The level of agreement between the authors was considered excellent (k = 0.810 for study selection and k = 0.941 for study eligibility). Our results reported a mean maxillary advancement of 5.69 mm, a mean vertical downward/upward of 2.85/-2.02 mm and a mean clockwise rotation of 4.15°. Greater surgical relapse rates were reported for vertical downward movement (-1.13 mm, 39.6%), followed by clockwise rotation (-1.41°, 33.9%), sagittal (-0.99 mm, 17.4%) and vertical upward (0.11 mm, 5.4%) movements. No relevance was found regarding the type of cleft, the type of Le Fort I osteotomy, concomitant bone grafting, surgical overcorrection, postoperative rigid or elastic intermaxillary fixation, or retention splint. Study limitations were heterogeneity and the low number of high-quality studies. In spite of reported high relapse rates, Le Fort I osteotomy for maxillary reposition is the first-choice procedure for selected cleft lip and palate patients in whom extensive maxillary movements are not required, because of its safety and its three-dimensional movement versatility in one-step surgery. Otherwise, distraction osteogenesis should be considered as the gold standard treatment.
一项系统评价检索基于 PICOS 方法，如下所示：人群：唇腭裂患者；干预措施：Le Fort I 截骨术；比较：不同的手术方案；结局：稳定性、复发或手术并发症；研究设计：仅排除了病例报告。审查未对语言或出版年份施加限制。分析了偏倚风险，评估了异质性，并使用 1%的显著性水平（p=0.01）进行了亚组分析。搜索共确定了 248 条引文，从中选择了 29 项研究，共纳入了 797 名患者。作者之间的一致性水平被认为非常好（研究选择的 k 值为 0.810，研究资格的 k 值为 0.941）。我们的研究结果报告平均上颌骨前徙 5.69mm，平均垂直向下/向上 2.85/-2.02mm，平均顺时针旋转 4.15°。报道了更大的手术复发率，垂直向下移动（-1.13mm，39.6%），随后顺时针旋转（-1.41°，33.9%），矢状面（-0.99mm，17.4%）和垂直向上（0.11mm，5.4%）。在类型的裂隙、Le Fort I 截骨术的类型、伴骨移植、手术过矫正、术后刚性或弹性颌间固定、或保持夹板方面没有相关性。研究局限性在于异质性和高质量研究数量少。尽管报告了较高的复发率，但 Le Fort I 截骨术用于上颌复位是需要广泛上颌运动的唇腭裂患者的首选手术方法，因为它的安全性和在一步手术中的三维运动多功能性。否则，应考虑牵引成骨术作为金标准治疗。
