ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title No Significant Difference in Velopharyngeal Function Between Conventional Orthognathic Surgery and Maxillary Distraction for Advancement of the Maxilla in Cleft Lip and Palate Patients
Clinical Question Is there a difference in the development of velopharyngeal insufficiency when maxillary advancement in the cleft patient is performed with conventional orthognathic surgery or distraction osteogenesis?
Clinical Bottom Line For repaired cleft lip and palate patients, there is no significant difference in development of velopharyngeal insufficiency after maxillary advancement due to conventional orthognathic (CO) surgery or distraction osteogenesis (DO). This is supported by two randomized clinical trials that found no significant difference in velopharyngeal function in four related criteria. A 2006 systematic review found that there were no prior trials directly comparing patient groups undergoing either CO or DO.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20413269Chua/2010Twenty-one Repaired Cleft Lip and Palate PatientsRandomized Controlled Trial
Key resultsThere was no significant difference between the two types of surgery in terms of velopharyngeal gap size (p>0.05), hypernasality (p>0.05), nasal emission (p>0.05), or mean nasalance scores (p>0.05).
#2) 17214524Chanchareonsook/2007Twenty-two Repaired Cleft Lip and Palate PatientsRandomized Controlled Trial
Key resultsThere was no significant difference between the two types of surgery in terms of velopharyngeal gap size (p=0.635), hypernasality (p=0.221), nasal emission (p=0.774), or mean nasalance scores (p=0.886).
#3) 16854207Chanchareonsook/2006747 cases of cleft and non cleft patients Systematic review of non-randomized trials
Key resultsNone of the 39 reviewed studies in this article directly compared conventional osteotomy and distraction osteogenesis.
Evidence Search velopharyngeal[All Fields] AND ("physiology"[Subheading] OR "physiology"[All Fields] OR "function"[All Fields] OR "physiology"[MeSH Terms] OR "function"[All Fields]) AND ("osteogenesis, distraction"[MeSH Terms] OR ("osteogenesis"[All Fields] AND "distraction"[All Fields]) OR "distraction osteogenesis"[All Fields] OR ("distraction"[All Fields] AND "osteogenesis"[All Fields])) AND ("orthognathic surgery"[MeSH Terms] OR ("orthognathic"[All Fields] AND "surgery"[All Fields]) OR "orthognathic surgery"[All Fields])
Comments on
The Evidence
Validity: While the 2006 systematic review noted that there were no studies directly comparing CO and DO, the two randomized clinical trials conducted since then are of reasonable quality. Both trials used similar groups that were randomized and treated similarly with high completion rates and compliance. Recall bias and competing interests are unlikely. The 2007 study includes results from only a 3-month post-operative assessment, and thus should be interpreted with some caution. The 2010 study had more extensive follow-up, including results from 3, 12, and 24-month post-operative assessments. Perspective: Velopharyngeal function is not a major determining factor in the decision between CO and DO. Other factors must be considered when choosing between CO and DO.
Applicability Other factors besides velopharyngeal function are more important in the decision between CO and DO for a particular patient. Factors that must also be considered include: 1.) Amount of advancement: Patients that require large maxillary advancement might more safely be treated with DO. 2.) Stability: CO and DO offer approximately equal stability. 3.) Predictability: CO offers greater predictability. 4.) Morbidity: When specifically considering maxillary advancement, morbidity is higher with DO. 5.) Treatment time: DO has a longer treatment time and requires two surgeries as opposed to one for CO. 6.) Patient comfort: Many patients consider the DO appliance to be cumbersome. 7.) Cost: DO is more expensive. 8.) Vascular supply: Vascular supply is more difficult to predict and maintain with CO.
Specialty/Discipline (Oral Surgery)
Keywords Distraction osteogenesis, Orthognathic
ID# 2625
Date of submission: 02/25/2014spacer
E-mail penner@livemail.uthscsa.edu
Author Jeff Penner
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward Ellis, III, DDS
Faculty mentor/Co-author e-mail ellise3@uthscsa.edu
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