T Moshal, I Roohani, M Jolibois, S Lasky, A Manasyan, P Naidu, N C O Munabi, M M Urata, J A Hammoudeh, W P Magee
{"title":"单侧唇腭裂患者术前鼻齿槽成型对中面部生长的影响：系统回顾与元分析","authors":"T Moshal, I Roohani, M Jolibois, S Lasky, A Manasyan, P Naidu, N C O Munabi, M M Urata, J A Hammoudeh, W P Magee","doi":"10.1177/10556656241286386","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Nasoalveolar molding (NAM) can optimize aesthetic outcomes in patients with cleft lip and palate (CLP), particularly in those with wider clefts. However, its impact on long-term postoperative sequelae such as midface hypoplasia (MFH) remains unclear. This study analyzed cephalometric data to evaluate NAM's effect on MFH in patients with complete unilateral CLP (UCLP).</p><p><strong>Design: </strong>Systematic Review and Meta Analysis.</p><p><strong>Patients: </strong>Included studies reported cephalometrics of patients ≥ 7 years old with repaired UCLP who underwent presurgical NAM versus no-NAM (control). Studies of bilateral cases or unoperated clefts were excluded.</p><p><strong>Main outcome measures: </strong>Main outcomes were cephalometric angles (sella-nasion-A point (SNA), sella-nasion-B point (SNB), and A point-nasion-B point (ANB)) of patients treated with NAM vs. no-NAM.</p><p><strong>Results: </strong>Of 2063 articles, three met inclusion criteria. Cephalometrics were reported for 171 patients (89 NAM, 82 no-NAM) at an average age of 8.5 ± 0.9 years. On pooled analysis, compared to the no-NAM cohort, the NAM cohort had insignificantly smaller SNA (78.8°±1.5° vs. 76.7°±1.5°, p = 0.169), SNB (75.5°±1.0° vs. 75.5°±1.0°, p = 0.954), and ANB (3.6°±1.4° vs. 1.23°±1.2°, p = 0.089) angles. Upon meta-analysis, compared to the no-NAM cohort, the NAM cohort had significantly smaller SNA (Mean Difference (MD) -1.96 [-3.31 to -0.61], p = 0.005) and ANB angles (MD -2.22 [-3.20 to -1.24], p < 0.001).</p><p><strong>Conclusion: </strong>This meta-analysis revealed that patients with UCLP who underwent presurgical NAM had significantly smaller SNA and ANB angles, possibly indicating worse MFH. Before choosing NAM, clinicians should consider CLP severity, potential sagittal growth restrictions, and feasibility, particularly in low-resource settings.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656241286386"},"PeriodicalIF":1.1000,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Impact of Presurgical Nasoalveolar Molding on Midface Growth in Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis.\",\"authors\":\"T Moshal, I Roohani, M Jolibois, S Lasky, A Manasyan, P Naidu, N C O Munabi, M M Urata, J A Hammoudeh, W P Magee\",\"doi\":\"10.1177/10556656241286386\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Nasoalveolar molding (NAM) can optimize aesthetic outcomes in patients with cleft lip and palate (CLP), particularly in those with wider clefts. However, its impact on long-term postoperative sequelae such as midface hypoplasia (MFH) remains unclear. This study analyzed cephalometric data to evaluate NAM's effect on MFH in patients with complete unilateral CLP (UCLP).</p><p><strong>Design: </strong>Systematic Review and Meta Analysis.</p><p><strong>Patients: </strong>Included studies reported cephalometrics of patients ≥ 7 years old with repaired UCLP who underwent presurgical NAM versus no-NAM (control). Studies of bilateral cases or unoperated clefts were excluded.</p><p><strong>Main outcome measures: </strong>Main outcomes were cephalometric angles (sella-nasion-A point (SNA), sella-nasion-B point (SNB), and A point-nasion-B point (ANB)) of patients treated with NAM vs. no-NAM.</p><p><strong>Results: </strong>Of 2063 articles, three met inclusion criteria. Cephalometrics were reported for 171 patients (89 NAM, 82 no-NAM) at an average age of 8.5 ± 0.9 years. On pooled analysis, compared to the no-NAM cohort, the NAM cohort had insignificantly smaller SNA (78.8°±1.5° vs. 76.7°±1.5°, p = 0.169), SNB (75.5°±1.0° vs. 75.5°±1.0°, p = 0.954), and ANB (3.6°±1.4° vs. 1.23°±1.2°, p = 0.089) angles. Upon meta-analysis, compared to the no-NAM cohort, the NAM cohort had significantly smaller SNA (Mean Difference (MD) -1.96 [-3.31 to -0.61], p = 0.005) and ANB angles (MD -2.22 [-3.20 to -1.24], p < 0.001).</p><p><strong>Conclusion: </strong>This meta-analysis revealed that patients with UCLP who underwent presurgical NAM had significantly smaller SNA and ANB angles, possibly indicating worse MFH. Before choosing NAM, clinicians should consider CLP severity, potential sagittal growth restrictions, and feasibility, particularly in low-resource settings.</p>\",\"PeriodicalId\":49220,\"journal\":{\"name\":\"Cleft Palate-Craniofacial Journal\",\"volume\":\" \",\"pages\":\"10556656241286386\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2024-12-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cleft Palate-Craniofacial Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/10556656241286386\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Dentistry\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cleft Palate-Craniofacial Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10556656241286386","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Dentistry","Score":null,"Total":0}
The Impact of Presurgical Nasoalveolar Molding on Midface Growth in Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis.
Objective: Nasoalveolar molding (NAM) can optimize aesthetic outcomes in patients with cleft lip and palate (CLP), particularly in those with wider clefts. However, its impact on long-term postoperative sequelae such as midface hypoplasia (MFH) remains unclear. This study analyzed cephalometric data to evaluate NAM's effect on MFH in patients with complete unilateral CLP (UCLP).
Design: Systematic Review and Meta Analysis.
Patients: Included studies reported cephalometrics of patients ≥ 7 years old with repaired UCLP who underwent presurgical NAM versus no-NAM (control). Studies of bilateral cases or unoperated clefts were excluded.
Main outcome measures: Main outcomes were cephalometric angles (sella-nasion-A point (SNA), sella-nasion-B point (SNB), and A point-nasion-B point (ANB)) of patients treated with NAM vs. no-NAM.
Results: Of 2063 articles, three met inclusion criteria. Cephalometrics were reported for 171 patients (89 NAM, 82 no-NAM) at an average age of 8.5 ± 0.9 years. On pooled analysis, compared to the no-NAM cohort, the NAM cohort had insignificantly smaller SNA (78.8°±1.5° vs. 76.7°±1.5°, p = 0.169), SNB (75.5°±1.0° vs. 75.5°±1.0°, p = 0.954), and ANB (3.6°±1.4° vs. 1.23°±1.2°, p = 0.089) angles. Upon meta-analysis, compared to the no-NAM cohort, the NAM cohort had significantly smaller SNA (Mean Difference (MD) -1.96 [-3.31 to -0.61], p = 0.005) and ANB angles (MD -2.22 [-3.20 to -1.24], p < 0.001).
Conclusion: This meta-analysis revealed that patients with UCLP who underwent presurgical NAM had significantly smaller SNA and ANB angles, possibly indicating worse MFH. Before choosing NAM, clinicians should consider CLP severity, potential sagittal growth restrictions, and feasibility, particularly in low-resource settings.
期刊介绍：
The Cleft Palate-Craniofacial Journal (CPCJ) is the premiere peer-reviewed, interdisciplinary, international journal dedicated to current research on etiology, prevention, diagnosis, and treatment in all areas pertaining to craniofacial anomalies. CPCJ reports on basic science and clinical research aimed at better elucidating the pathogenesis, pathology, and optimal methods of treatment of cleft and craniofacial anomalies. The journal strives to foster communication and cooperation among professionals from all specialties.
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