Changes in Airway Dimensions After Face-Mask Therapy in Cleft Lip and Palate and Non-cleft Patients: Systematic Review and Meta-analysis

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Erfan Bardideh ◽  
Maliheh Dadgarmoghaddam ◽  
Hooman Shafaee ◽  
Bahareh Mazloumhoseini
Keyword(s):  
Systematic Review ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Meta Analysis ◽  
Treatment Protocol ◽  
Face Mask ◽  
Treatment Protocols ◽  
Hand Search ◽  
Central Register ◽  
Airway Dimensions

Context: Maxillary deficiency can lead to the reduction of airway space and increase the chances of development of obstructive airway disorders. Facemask therapy is one of the main treatment protocols in developing maxillary deficient patients. Objectives: The purpose of this systematic review and meta-analysis was to assess the changes in the airway dimensions after face-mask therapy in both cleft lip and palate and non-cleft patients. Data Sources: A systematic search in different electronic databases (EMBASE, Pubmed, Cochrance Central register of controlled trials), IADR proceedings and a hand search by October 2020 were conducted and a meta-analysis and systematic review was performed. Results: In patients without cleft lip and palate, upper pharyngeal width was significantly increased by mean of 2.05mm (CI = 95%, 0.61 - 3.50) following facemask therapy in comparison to patients who did not receive the treatment.Other upper pharyngeal (nasopharyngeal) measurements also showed a statistically significant improvement after therapy: S-PNS by 4.64mm (CI = 95%, 3.34 - 5.94), AD1-PNS by 3.81 mm (CI = 95%, 2.40 - 5.21), AD2-PNS by 2.90 mm (CI = 95%, 0.13 - 5.67) and Pm’-SPL by 2.53 (CI = 95%, 0.54 - 4.51). Lower pharyngeal measurments did not show any significant changes after the treatment (P > 0.05).In the analysis of studies with 3D imaging modalities, upper pharyngeal volume was also significantly increased by 499.29mm3 (CI = 95%, 69.58-929.00) after the treatment. In addition, a review of articles that included cleft lip and palate patients also showed after the treatment, the upper pharyngeal measurements all showed a significant improvement (P < 0.05), whereas the oropharyngeal region was relatively stable. Conclusions: In maxillary deficient patients with or without an orofacial cleft, facemask therapy can improve the nasopharyngeal area dimensions; however, this treatment protocol appears not to have an effect on the oropharyngeal area of the airway tract.

Early Two-Stage Palatoplasty Using Modified Furlow's Veloplasty

2010 ◽  
Vol 47 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Nishio Juntaro ◽  
Yamanishi Tadashi ◽  
Hiroshi Kohara ◽  
Yoshiko Hirano ◽  
Michiyo Sako ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Protocol ◽  
Dental Occlusion ◽  
Central Incisor ◽  
Two Stage ◽  
Treatment Protocols ◽  
Normal Occlusion ◽  
New Treatment ◽  
Velopharyngeal Function

Objective To achieve sufficient velopharyngeal function and maxillary growth for patients with unilateral cleft lip and palate (UCLP), the authors have designed a new treatment protocol for palate closure involving early two-stage palatoplasty with modified Furlow veloplasty. Details of the surgical protocol and the outcomes of the dental occlusion of patients at 4 years of age are presented. Design and Setting This was an institutional retrospective study. Patients Seventy-two UCLP patients were divided into two groups based on their treatment protocols: patients treated using the early two-stage palatoplasty protocol (ETS group; n = 30) and patients treated using Wardill-Kilner push-back palatoplasty performed at 1 year of age (PB group; n = 42). Interventions The features of the ETS protocol are as follows: The soft palate is repaired at 12 months of age using a modified Furlow technique. The residual cleft in the hard palate is closed at 18 months of age. Lip repair is carried out at 3 months of age with a modified Millard technique for all subjects. Results The ETS group showed a significantly better occlusal condition than the PB group. The incidence of normal occlusion at the noncleft side central incisor was 7.1% in the PB group; whereas, it was 66.7% in the ETS group. Conclusion The results indicate that the early two-stage protocol is advantageous for UCLP children in attaining better dental occlusion at 4 years of age.

scholarly journals Efficaciousness of dexmedetomidine in children undergoing cleft lip and palate repair: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046798
Author(s):  
Dengfeng Liu ◽  
Li Pan ◽  
Yin Gao ◽  
Jiefan Liu ◽  
Feng Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Random Effect Model ◽  
Control Group ◽  
Paediatric Patients ◽  
The Impact

ObjectiveTo systematically assess the efficacy and safety of dexmedetomidine as an anaesthesia adjuvant for cleft lip and palate (CLP) repair in children.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP) and Wanfang (up to October 2020). Studies in languages other than English and Chinese were excluded.Eligibility criteria for selecting studiesRandomised controlled trials (RCTs) evaluating the impact of dexmedetomidine on emergence agitation (EA), the need for postoperative rescue analgesics, postoperative nausea and vomiting (PONV), and other adverse events in paediatric patients during CLP repair.Data extraction and synthesisThe quality of evidence was assessed by using the Cochrane Review Methods and the Grading of Recommendations Assessment, Development and Evaluation approach. Data were screened, extracted and assessed by two independent authors. Outcomes were reported as a risk ratio (RR) with a 95% CI. A random-effect model was used when heterogeneity was detected.ResultsThirteen studies including 1040 children met the inclusion criteria. The incidence of EA was significantly decreased in the dexmedetomidine group (RR, 0.19; 95% CI 0.10 to 0.36; p<0.00001; I2=56%) as compared with the control group. Paediatric patients receiving dexmedetomidine had lower postoperative analgesic requirements (RR, 0.27; 95% CI 0.10 to 0.73; p=0.01; I2=84%) and a lower incidence of respiratory adverse events (RR, 0.49; 95% CI 0.31 to 0.78; p=0.003; I2=0%). There were no significant differences in the risk of PONV and cardiovascular adverse events.ConclusionsThere was a lack of high-quality studies in this field. Perioperative administration of dexmedetomidine reduced the need for postoperative rescue analgesics and the incidence of EA in children without side effects undergoing CLP repair. However, further verification with larger samples and higher-quality RCTs is needed.

Cranial Base Angle in Patients With Cleft Lip and Palate—A Systematic Review and Meta-Analysis

2021 ◽  
pp. 105566562110535
Author(s):  
Chandnee Murugan ◽  
Vignesh Kailasam
Keyword(s):  
Systematic Review ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Meta Analysis ◽  
Cranial Base ◽  
Class I ◽  
Base Angle ◽  
Registration Number ◽  
Newcastle Ottawa Scale ◽  
Ottawa Scale

Background: Diverse findings have been reported for the cranial base angle (CBA) in patients with CLP (cleft lip and palate) and non-CLP controls. Objective: The aim of this study is to assess and evaluate the CBA in patients with CLP and non-CLP controls. Methods: Data from PubMed, OVID Technologies, Inc., Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science, and EMBASE for Excerpta Medica dataBASE (EMBASE) with relevant terms was extracted until December 31, 2020. Inclusion criteria were data of patients with non-syndromic unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). In the case of UCLP and BCLP, patients with craniofacial syndromes were excluded. The study proposal was registered with PROSPERO (Registration number: CRD42021228632). Results: Fifteen studies with a total of 2032 participants were included for the systematic review and 14 studies with a total of 1972 participants were included for the meta-analysis. The risk of bias was assessed using the Modified Newcastle Ottawa scale under seven domains by two authors. Thirteen studies were graded as “good” and two as “satisfactory.” The CBA in patients with CLP were greater than the non CLP Class I controls in six of the 15 studies. CBA was greater in patients with CLP than non-CLP controls by 1.21° (95% CI of 0.19-2.22). Meta-analysis reported considerable heterogeneity (I2 = 86%). Anterior (ACB) and posterior cranial base (PCB) lengths were shorter in patients with CLP than in the non-cleft Class I controls by 2.14 mm (95% CI of 0.99-3.30) and 2.06 mm (95% CI of 1.52-2.60), respectively. Conclusion: Most studies were graded as good. Patients with CLP had greater CBA and shorter ACB and PCB lengths when compared to non-CLP controls.

Efficacy of rhBMP-2 in Cleft Lip and Palate Defects: Systematic Review and Meta-analysis

2018 ◽  
Vol 104 (2) ◽  
pp. 115-129 ◽  
Author(s):  
Wellington Luiz de Oliveira da Rosa ◽  
Tiago Machado da Silva ◽  
Arthur Dias Galarça ◽  
Evandro Piva ◽  
Adriana Fernandes da Silva
Keyword(s):  
Systematic Review ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Meta Analysis

scholarly journals Maxillary Growth and Speech Outcome in Patient with Cleft Lip and Palate after Two-Stage Palate Repair: A Systematic Review

1970 ◽  
Vol 1 (4) ◽  
Author(s):  
Mulyadi Mulyadi ◽  
Prasetyanugraheni Kreshanti ◽  
Siti Handayani ◽  
Kristaninta Bangun
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Literature Search ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Protocol ◽  
Two Stage ◽  
Language Studies ◽  
Palate Repair ◽  
Maxillary Growth

Background: The management of patients with cleft lip and palate is complex, where the treatment outcome is judged on the balance between aesthetics, speech, and maxillary growth. Up to now, there is no generally accepted treatment protocol. Every center must find the best-suited protocol treatment for their population. Methods: A systematic review through literature search was conducted for English-language studies in PubMed. This search was conducted in September 2011 using EndNote X3 with keywords: Two-stage Palate Repair and Maxillary Growth and Two-stage Palate Repair and Speech Outcome. Both retrospective and prospective studies on maxillary growth and speech outcome in patient with cleft lip and palate after two-stage palate repair published from 2001 to 2012 were included. Result: From the reviewed of 37 articles, only 14 articles fit the inclusions criteria, three articles discussed the outcome of maxillary growth and speech outcome, eight articles only discussed the maxillary growth and the rest of articles only discussed the speech outcome. Conclusion:From this review we found that most of the two-stage palate repair results in better maxillary growth, but only few of them results in good speech outcome. We will perform further study based on this review to discover a new protocol for the management of palate repair in our center.

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