Nasal symmetry after different techniques of primary lip repair for unilateral complete cleft lip with or without cleft of the alveolus and palate: A systematic review |
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| Affiliation: | 1. Department of Dentistry, All India Institute of Medical Sciences, AIIMS, Deoghar, Jharkhand, 814152, India;2. GSR Institute of Cranio-Maxillofacial and Facial Plastic Surgery, Vinay Nagar Colony, I S Sadan, Saidabad, Hyderabad, Telangana, 500059, India;3. Department of Dentistry, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand, 249203, India;4. Emeritus Consultant, Maxillofacial Surgeon, Poole Hospital, University of Bournemouth, University of Duisburg-Essen, Trinity College Dublin, India;5. Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Freiburgstrasse 7, CH-3010 Bern, Switzerland;6. Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;7. Faculty of Dentistry, Universitas Indonesia, Campus Salemba, Jalan Salemba Raya No.4, Jakarta, 10430, Indonesia;1. Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588 Japan;2. Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588 Japan;3. Department of Oral Surgery, Imakiire General Hospital, 43-25 Korai-Cho, Kagoshima, 890-0051 Japan;1. Oral and Maxillofacial Surgeon, Hospital Universitario La Samaritana, Bogotá, Colombia;2. Department of Oral Research, Institución Universitaria Colegios de Colombia, Bogotá, Colombia;3. Oral and Maxillofacial Service, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia;4. Oral and Maxillofacial Surgery Program, Universidad El Bosque, Bogotá, Colombia;5. Unit of Basic Oral Investigation (UIBO), Facultad de Odontología, Universidad El Bosque, Bogotá, Colombia;6. Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Madrid, Spain;1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China |
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| Abstract: | ![]()
The aim of this systematic review was to establish the effect of different surgical repairs for the lip on nasal symmetry. PubMed, Scopus, Embase, Cochrane CENTRAL, and Ovid databases search was performed initially for only English-language articles, in patients with unilateral complete cleft lip with or without cleft alveolus and palate (UCCLAP) who were younger than 1 year of age and undergoing cleft lip repair, and are published from the earliest data available up to December 31, 2020. The primary outcome variable was nasal symmetry, with reported complications being secondary variables. A qualitative synthesis was provided. A total of 19,828 records were obtained, and 17 articles were selected for final review. Assessment of the risk of bias of the included randomized controlled trials (RCTs) (N-1) was done with the Cochrane Risk of Bias 2 (RoB-2) tool, and the ROBINS-I tool was used for non-randomized studies (n = 14). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to evaluate the quality of the body of evidence. The majority of the included studies compared the triangular repair with the rotation advancement (RA) techniques, and preferred RA or its modifications. In terms of the nasal symmetry, the Fisher repair proved to be superior to the RA technique. Neither RA nor straight line repair was superior to one another. The Delaire technique may be preferred over the modified RA. Also, satisfactory outcomes were observed with simultaneous lip?nose repair. This systematic review examined a plethora of techniques, and the heterogeneity between studies was very high regarding type of surgery, method of nasal symmetry assessment, and length of follow-up, thus producing low-quality evidence; therefore, results should be interpreted with caution. Future research requires RCTs with larger sample sizes and appropriate length of follow-up, and surgeries preferably performed by a single experienced surgeon. |
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| Keywords: | Unilateral complete cleft lip Nasal deformity Systematic review Rotation advancement technique Triangular technique |
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