Highlighted review: Maxillary distraction osteogenesis versus orthognathic surgery for cleft patients

Dimitrios Kloukos, Piotr Fudalej, Patrick Sequeira‐Byron, Christos Katsaros

Plain language summary: Maxillary distraction osteogenesis versus orthognathic surgery for cleft patients

Background
Cleft lip and palate is one of the most common birth defects and can cause difficulties with feeding, speech and hearing, as well as psychosocial problems. Treatment of clefts is lengthy, typically taking from birth to adulthood to complete. Upper jaw growth in cleft patients is highly variable, and in a relatively high percentage, it does not develop completely.

A type of surgery called orthognathic surgery, which involves surgical cutting of bone to realign the upper jaw (osteotomy), is usually performed in this situation. An alternative intervention is known as distraction osteogenesis, which achieves bone lengthening by gradual mechanical distraction (cutting of bone and moving the ends apart incrementally to allow new bone to form in the gap). This review is an update of the original version that was published in 2016.

Review question
This review, produced through Cochrane Oral Health, examines the benefits and risks of distraction osteogenesis for advancing the upper jaw compared to conventional orthognathic surgery in adolescents and adults.

Study characteristics
The evidence on which this review is based is up to date as of 15 May 2018. We found six relevant articles to include in this review. All are related to one single study conducted in Hong Kong between 2002 and 2008. The study involved 47 participants aged 13 to 45 years of age.

It investigated the effects of the two surgical procedures on alteration of face morphology, stability of upper jaw after surgery, speech and velopharyngeal function (ability to close the gap between the soft palate and nasal cavity to produce sound), psychological status of the participants and clinical side effects.

Key results
Both procedures were effective in producing better facial structure in cleft patients. Upper jaw was more stable in the distraction osteogenesis group than the conventional osteotomy group five years after surgery. There was no difference in speech and velopharyngeal function between the procedures.

Social self esteem in the maxillary distraction group initially seemed to be lower than in the conventional surgery group, but this improved over time and the distraction group had higher satisfaction with life two years after surgery.

Side effects included deterioration of the fit between the teeth when the mouth is closed and infection of muscous membranes of the nose and mouth, but the frequency of these problems was similar between groups. There was no severe harm to any participant.

Quality of the evidence
We judged the quality of the evidence to be very low. The one study was small and there were concerns about aspects of its design and reporting; therefore we have found no reliable evidence as to which procedure should be regarded superior. High quality clinical trials, which involve lots of people, and different face types, are required to guide decision making.

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Citation: Kloukos  D, Fudalej  P, Sequeira‐Byron  P, Katsaros  C. Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD010403. DOI: 10.1002/14651858.CD010403.pub3.