Grillo Ricardo, Gomes Bruno, Reis Tenyson, Candido Isabella Romão, Miloro Michael, Borba Alexandre Meireles
Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil.
Department of Oral and Maxillofacial Surgery, General Hospital of Cuiaba, Cuiaba, Mato Grosso, Brazil.
J Craniomaxillofac Surg. 2023 Jan;51(1):60-66. doi: 10.1016/j.jcms.2023.01.004. Epub 2023 Jan 13.
The aim of this study was to determine whether the benefits of orthognathic surgery in a growing individual outweigh its risks. A scoping review was performed according to the PRISMA-ScR guideline. A bibliographic search from MEDLINE, Cochrane Library and LILACS was conducted until February 1, 2022. Scientific publications which reported orthognathic surgery in individuals under 18 years of age were considered. Inclusion criteria were performed according to PICOS model: do individuals with dentofacial deformity submitted to orthognathic surgery with an immature skeleton other than waiting growth cessation have overall benefits over any possible pos-operative consequences? Predictor of interest was growth status and outcome variables were positive benefits or negative consequences related to orthognathic surgery. Two reviewers screened records independently, and any disagreement between them was resolved by a third reviewer. Eligible studies were compiled into an extraction data form and were verified for validity and reliability. Risk of bias between studies was carried out using Review Manager. A total of 15 articles were included in this scoping review, comprising retrospective studies (9), case reports (3), and surveys (3). The topics covered varied from assessment of the functional needs, role, quality of life after orthognathic surgery, impact on growth, relation with temporomandibular joint surgical treatments, minimal referral age for surgery by orthodontists and complex cranio-maxillofacial deformities. Due to the heterogeneity of the articles, it was not possible to perform a meta-analysis. Within the limitations of the study it seems that the existing evidence seems favorable towards the intervention, improving quality of life in growing individuals, even at the risk of a second surgery.
本研究的目的是确定正颌手术对正在生长发育的个体的益处是否大于其风险。根据PRISMA-ScR指南进行了一项范围综述。截至2022年2月1日，对MEDLINE、Cochrane图书馆和LILACS进行了文献检索。纳入了报道18岁以下个体正颌手术的科学出版物。纳入标准根据PICOS模型制定：与等待生长停止相比，接受正颌手术且骨骼未成熟的牙颌面畸形个体是否总体上比任何可能的术后后果更有益？感兴趣的预测因素是生长状态，结果变量是与正颌手术相关的积极益处或消极后果。两名评审员独立筛选记录，他们之间的任何分歧由第三名评审员解决。符合条件的研究被整理成提取数据表格，并对其有效性和可靠性进行了验证。使用Review Manager对研究之间的偏倚风险进行评估。本范围综述共纳入15篇文章，包括回顾性研究（9篇）、病例报告（3篇）和调查（3篇）。涵盖的主题包括功能需求评估、正颌手术后的作用、生活质量、对生长的影响、与颞下颌关节手术治疗的关系、正畸医生建议的最小手术年龄以及复杂的颅颌面畸形。由于文章的异质性，无法进行荟萃分析。在本研究的局限性内，现有证据似乎有利于该干预措施，即使存在二次手术的风险，也能改善正在生长发育个体的生活质量。
