非综合征唇腭裂患者通过内外牵引成骨法进行 Lefort-1 推进的比较：系统回顾和荟萃分析

IF 0.4 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Journal of Oral and Maxillofacial Surgery Medicine and Pathology Pub Date : 2024-08-03 DOI:10.1016/j.ajoms.2024.08.002

Sameer Pandey , Ashi Chug , Srinivas Gosla Reddy , Saurabh S. Simre

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引用次数: 0

摘要

目的在 25% 的唇腭裂（CLP）患者中，面中部发育不良（MH）对正畸无反应。唇腭裂患者手术后的瘢痕会导致传统截骨术的大量复发。牵引成骨术（DO）已成为治疗CLP患者面中部发育不良的首选方法。本系统综述旨在提供证据，以指导非综合征CLP相关上颌骨发育不良的牵引装置的选择。纳入了针对非综合征CLP患者的LeFort 1牵引成骨的研究。检索了四个文献数据库（PubMed、Embase、Cochrane 和 Ovid）。根据 PICOS 标准对确定的研究进行筛选，以提取数据。提取了牵引前、牵引后 1 年内和 1 年后的 SNA、SNB 和 ANB 角度测量值。生成森林图以了解与外牵引器和内牵引器相关的上颌前突和复发情况。对非随机研究进行了偏倚风险评估，并生成了交通灯图和摘要图以进行推断。131篇文章被纳入全文综述，31篇文章被选中进行数据综合。共有 361 名患者接受了牵张成骨术，其中 265 名患者接受了外牵张成骨术，96 名患者接受了内牵张成骨术。综合数据分析显示，外侧牵引比内侧牵引的 SNA 角度增加更大。外部牵引的复发率更高。

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Comparison of Lefort-1 advancement by internal and external distraction osteogenesis in non-syndromic cleft lip and palate: A systematic review and meta-analysis

Purpose

In 25 % of Cleft lip and palate (CLP) patients, midface hypoplasia (MH) is non-responsive to orthodontics. Post-surgical scarring in cleft patients causes large relapse with conventional osteotomies. Distraction osteogenesis (DO) has become the choice of treatment for midface hypoplasia in CLP patient. The systematic review aims to generate evidence to guide the selection of distraction devices for non-syndromic CLP associated maxillary hypoplasia.

Materials and methods

A PRISMA-guided systematic review was planned. Studies with LeFort 1 distraction osteogenesis in non-syndromic CLP patients were included. Four literature databases (PubMed, Embase, Cochrane and Ovid) were searched. Identified studies were shortlisted based on PICOS criteria for data extraction. SNA, SNB and ANB angle measurements were extracted pre-distraction and within 1 year and after 1-year post-distraction. Forest plots were generated to understand the maxillary advancement and relapse associated with external and internal distractor. Risk of bias was evaluated for non-randomized studies and a traffic light plot as well as summary plot was generated for inference.

Results

A total of 2395 articles were identified after a database search. 131 articles were included for full-text review and 31 articles were selected for data synthesis. A total of 361 patients underwent distraction osteogenesis, out of which 265 patients underwent external DO, and 96 underwent internal DO. Pooled data analysis revealed a larger increase in SNA angle for external distractors than internal distractors.