Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Cleft Palate Craniofac J. 2024 Jan;61(1):20-32. doi: 10.1177/10556656221116005. Epub 2022 Jul 25.
Midface hypoplasia (MFH) is a long-term sequela of cleft lip and palate repair, and is poorly understood. No study has examined the aggregate data on sagittal growth restriction of the midface following repair of the lip, but not palate, in these patients. A systematic review of 3780 articles was performed. Twenty-four studies met inclusion criteria and 11 reported cephalometric measurements amenable to meta-analysis. Patients with Veau class I-III palatal clefts were included so long as they had undergone only lip repair. Groups were compared against both noncleft and unrepaired controls. Cephalometrics were reported for 326 patients (31.3% female). Noncleft controls had an average SNA angle of 81.25° ± 3.12°. The only patients demonstrating hypoplastic SNA angles were those with unilateral CLP with isolated lip repair (77.4° ± 4.22°). Patients with repaired CL had SNA angles similar to noncleft controls (81.4° ± 4.02°). Patients with unrepaired CLP and CL tended toward more protruding maxillae, with SNA angles of 83.3° ± 4.04° and 87.9° ± 3.11°, respectively. Notably, when comparing SNA angles between groups, patients with CLP with isolated lip repair had significantly more hypoplastic angles compared to those with repaired CL ( < .0001). Patients with CLP with isolated lip repair were also more hypoplastic than noncleft controls ( < .0001). In contrast, there was no significant difference between the SNA of patients with repaired CL and controls ( = .648). We found that cleft lip repair only appeared to contribute to MFH in the setting of concurrent cleft palate pathology, suggesting that scarring from lip repair itself is unlikely to be the predominant driver of MFH development. However, studies generally suffered from inadequate reporting of timing, technique, follow-up time, and cleft severity.
面中部发育不全（MFH）是唇裂和腭裂修复的长期后遗症，目前对此了解甚少。没有研究检查过这些患者中唇裂而不是腭裂修复后面中部矢状生长受限的综合数据。对 3780 篇文章进行了系统回顾。24 项研究符合纳入标准，其中 11 项报告了可进行荟萃分析的头影测量数据。纳入了 Veau Ⅰ-Ⅲ 类腭裂患者，只要他们只接受了唇修复。将这些组与非裂隙和未修复对照组进行比较。共报告了 326 例患者（31.3%为女性）的头影测量数据。非裂隙对照组的平均 SNA 角为 81.25°±3.12°。唯一表现出 SNA 角发育不全的患者是单侧唇裂伴单侧唇裂修复的患者（77.4°±4.22°）。接受修复的 CL 患者的 SNA 角与非裂隙对照组相似（81.4°±4.02°）。未修复的 CLP 和 CL 患者的上颌骨更突出，SNA 角分别为 83.3°±4.04°和 87.9°±3.11°。值得注意的是，在比较各组之间的 SNA 角时，单侧唇裂伴单侧唇裂修复的患者的 SNA 角明显更发育不全，与接受修复的 CL 患者相比（ < .0001）。单侧唇裂伴单侧唇裂修复的患者也比非裂隙对照组更发育不全（ < .0001）。相比之下，接受修复的 CL 患者的 SNA 与对照组之间没有显著差异（ = .648）。我们发现，只有在并发腭裂病理的情况下，唇裂修复似乎才会导致 MFH，这表明唇裂修复本身的疤痕不太可能是 MFH 发展的主要驱动因素。然而，这些研究通常在报告时间、技术、随访时间和裂隙严重程度方面存在不足。
