Bansal Adity, Reddy Srinivas Gosla, Chug Ashi, Markus Anthony F, Kuijpers-Jagtman Anne Marie
Department of Dentistry, All India Institute of Medical Sciences, AIIMS, Deoghar, Jharkhand, 814152, India.
GSR Institute of Cranio-Maxillofacial and Facial Plastic Surgery, Vinay Nagar Colony, I S Sadan, Saidabad, Hyderabad, Telangana, 500059, India.
J Craniomaxillofac Surg. 2022 Dec;50(12):894-909. doi: 10.1016/j.jcms.2022.12.006. Epub 2023 Jan 5.
The aim of this systematic review was to establish the effect of different surgical repairs for the lip on nasal symmetry. PubMed, Scopus, Embase, Cochrane CENTRAL, and Ovid databases search was performed initially for only English-language articles, in patients with unilateral complete cleft lip with or without cleft alveolus and palate (UCCLAP) who were younger than 1 year of age and undergoing cleft lip repair, and are published from the earliest data available up to December 31, 2020. The primary outcome variable was nasal symmetry, with reported complications being secondary variables. A qualitative synthesis was provided. A total of 19,828 records were obtained, and 17 articles were selected for final review. Assessment of the risk of bias of the included randomized controlled trials (RCTs) (N-1) was done with the Cochrane Risk of Bias 2 (RoB-2) tool, and the ROBINS-I tool was used for non-randomized studies (n = 14). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to evaluate the quality of the body of evidence. The majority of the included studies compared the triangular repair with the rotation advancement (RA) techniques, and preferred RA or its modifications. In terms of the nasal symmetry, the Fisher repair proved to be superior to the RA technique. Neither RA nor straight line repair was superior to one another. The Delaire technique may be preferred over the modified RA. Also, satisfactory outcomes were observed with simultaneous lip-nose repair. This systematic review examined a plethora of techniques, and the heterogeneity between studies was very high regarding type of surgery, method of nasal symmetry assessment, and length of follow-up, thus producing low-quality evidence; therefore, results should be interpreted with caution. Future research requires RCTs with larger sample sizes and appropriate length of follow-up, and surgeries preferably performed by a single experienced surgeon.
本系统评价的目的是确定不同唇部手术修复对鼻对称性的影响。最初在PubMed、Scopus、Embase、Cochrane CENTRAL和Ovid数据库中检索仅为英文的文章，研究对象为年龄小于1岁、患有单侧完全性唇裂（伴或不伴牙槽突裂和腭裂，UCCLAP）且正在接受唇裂修复的患者，检索时间从最早可用数据至2020年12月31日。主要结局变量为鼻对称性，报告的并发症为次要变量。进行了定性综合分析。共获得19828条记录，最终筛选出17篇文章进行综述。采用Cochrane偏倚风险2（RoB-2）工具对纳入的随机对照试验（RCTs）（N = 1）进行偏倚风险评估，采用ROBINS-I工具对非随机研究（n = 14）进行评估。应用推荐分级、评估、制定和评价（GRADE）方法评估证据体的质量。大多数纳入研究比较了三角修复术与旋转推进（RA）技术，并更倾向于RA或其改良术式。在鼻对称性方面，Fisher修复术被证明优于RA技术。RA修复术和直线修复术之间没有优劣之分。Delaire技术可能比改良RA技术更受青睐。同时进行唇鼻修复也观察到了满意的效果。本系统评价研究了大量技术，研究之间在手术类型、鼻对称性评估方法和随访时间方面的异质性非常高，因此产生的证据质量较低；因此，对结果的解释应谨慎。未来的研究需要样本量更大、随访时间合适的RCTs，并且手术最好由同一位经验丰富的外科医生进行。
