Impact of primary palatoplasty on the maxillomandibular sagittal relationship in patients with unilateral cleft lip and palate: a systematic review and meta-analysis

The study objective was to evaluate, through a meta-analysis, the impact of primary palatoplasty on the sagittal maxillary and mandibular relationship among patients with complete unilateral cleft lip and palate (UCLP). Electronic database and hand searches were performed. Controlled clinical trials involving non-syndromic UCLP patients were included. Selected papers had to include a group of patients undergoing lip and palate repair and a group undergoing lip repair only. Data heterogeneity was demonstrated and individual means, standard deviations, and sample sizes were collected and summarized using a random effects model meta-analysis. Although six articles were selected for the systematic review, only four were included in the meta-analysis due to large discrepancies in the standard surgical protocol. Only one variable assessing the intermaxillary relationship (A point-nasion-B point; ANB), maxillary position (sella-nasion-A point; SNA), and mandibular position (sella-nasion-B point; SNB) was common among the selected studies. No significant differences in SNA and SNB were indentified between patients undergoing lip surgery alone and those undergoing lip and palate surgery. Evaluation of ANB showed a small statistical standard mean difference of 0.36°. Impaired maxillary sagittal growth, observed in patients with UCLP, appears to be a basic consequence of lip surgical repair. Additional changes to the maxilla and mandible produced by palatal repair are minor. Methodologically rigorous controlled studies are needed to provide a stronger evidence-based basis for the surgical management of patients with UCLP.