目的:比较上颌前牵张术(AMD)与LeFortI截骨术和上颌全牵张成骨术(TMDO)治疗上颌骨发育不全的疗效和疗效。
方法:(PROSPEROCRD42020223345)对七个数据库进行全面的电子搜索,未发表的灰色文献,并手动搜索相关研究参考列表。评估面部中部骨骼的研究,齿状肺泡,年龄>8岁的AMD患者的软组织结局,上颌骨发育不良,并包括TMDO/LeFort1/两者作为对照组。评估了7篇纳入的文章的研究特征和定性综合。使用RevMan5.4软件对三项研究进行定量分析。使用CochraneROB2评估研究质量,使用GRADE评估证据的总体确定性。
结果:在241名受试者中进行了AMD,LeFort1在145个科目中,和TMDO在42个科目。AMD和LeFort1组的上颌前移没有统计学上的显着差异(平均差异,MD-0.64°),而TMDO显示出比AMD(MD-1.44°)有统计学意义的进步。与Lefort1相比,AMD(MD-6.15度)发现上颌骨前部向上旋转具有统计学意义。AMD和TMDO组上切牙倾斜度均有改善(MD1.5°)。改善上颌骨-下颌骨关系,面的凸度,嘴唇和鼻子,在所有三组中,都注意到牙槽的过度喷射和上切牙位置有明显的变化。在LeFort1和TMDO中注意到明显的气道改变。AMD的总复发最少。
结论:与LeFort1相比,牵张成骨表现出更好的骨-骨骼结局和轻微的骨骼复发。与AMD相比,TMDO是治疗与CLP相关的严重上颌发育不全的优选方式。需要进一步的长期前瞻性比较研究,可能涉及以患者为中心的优点。
To compare the treatment outcomes and effectiveness of Anterior Maxillary Distraction (AMD) with the LeFort I Osteotomy and Total Maxillary Distraction Osteogenesis (TMDO) to treat cleft maxillary hypoplasia.
(PROSPERO CRD42020223345) Thorough electronic search of seven databases, unpublished gray literature, and a hand search of the relevant studies reference lists was done. Studies assessing mid-facial skeletal, dentoalveolar, and soft-tissue outcomes of AMD in patients >8 years of age, hypoplastic cleft maxilla, and with either TMDO/LeFort 1/ both as control groups were included. Seven included articles were assessed for the study characteristics and qualitative synthesis. Three studies were analyzed quantitatively using the RevMan 5.4 software. The quality of studies was assessed using Cochrane ROB2 and the overall certainty of evidence using GRADE.
AMD was performed in 241 subjects, LeFort 1 in 145 subjects, and TMDO in 42 subjects. Maxillary advancement for AMD and LeFort 1 groups showed no statistically significant difference (Mean Difference, MD -0.64°) while TMDO showed statistically significant advancement than AMD (MD -1.44°). Statistically significant upward rotation of anterior maxilla was noted with AMD (MD -6.15 degrees) than Lefort 1. Upper incisor inclination improved in both AMD and TMDO groups (MD 1.5°). Improvement in the maxilla-mandibular relationship, convexity of face, lip and nose, and marked dentoalveolar changes in overjet and upper incisor position were noted in all the three groups. Discernible airway alterations were noted in LeFort 1 and TMDOs. Total relapse was the least with AMD.
Distraction osteogenesis exhibited better dento-skeletal outcomes and minor skeletal relapse than LeFort 1. TMDO is a preferred modality in treating severe maxillary hypoplasia associated with CLP than AMD. Further long-term prospective comparative studies are required, possibly involving the patient-centric merits.