IADR Abstract Archives
Comparison of 1-Stage and 2-Stage Palatoplasty: a Systematic Review and Meta-Analysis
Objectives: The choice between different palatoplasty procedures for a complete cleft lip and palate repair is a challenge in maxillofacial surgery worldwide. There is an unmet medical need to provide guidance for this question. Therefore we aimed to evaluate and compare the maxillofacial and speech development after 1-stage and 2-stage palatoplasty.
Methods: This meta-analysis was performed using Medline, Embase and Cochrane Central database until March 2022 with the PROSPERO registration number CRD42021289846. Our methodology is based on the PRISMA statement. All the studies were retrospective and cross-sectional studies written in English. The analyzed outcomes included lateral cephalometry (SNA, ANB, SN-PP, U1-PP), audible nasal air leakage, velopharyngeal insufficiency, hypernasality and anterior cross-bite. The results were analyzed using the Random effect model, represented as standardized mean difference (SMD) and Odds ratio (OR).The Risk of Bias was assessed by the ROBINS-I tool, while the level of evidence by GRADE analysis.
Results: From a total of 194 articles after our systematic search 17 studies with 885 patients were eligible for analysis. A statistically significant difference was found for the U1-PP, audible nasal air leakage and velopharyngeal insufficiency outcome, favoring the 1-stage approach (SMD 2.35 [0.18; 4.15]; OR 0.27 [0.07; 1.00]; OR 0.27 [0.08; 0.85], respectively). The statistical analysis of hypernasality showed a tendency towards lower odds, favoring the 1-stage method (OR 0.49 [0.17; 1.40]). For SNA, ANB, SN-PP and anterior cross-bite no superiority could be shown favoring one method over the other (SMD -0.28 [-1.32; 0.75]; SMD -0.4 [-1.26; 0.45]; SMD -0.31 [-1.59; 0.97]; SMD 1.40 [0.82; 2.41] respectively).
Conclusions: 1-stage palatoplasty provides better speech development ,while maxillofacial development does not differ substantially between 1-stage and 2-stage surgery. Thus the 1-stage method may serve as the first choice for operation unless obstacles appear in individual patients.
Methods: This meta-analysis was performed using Medline, Embase and Cochrane Central database until March 2022 with the PROSPERO registration number CRD42021289846. Our methodology is based on the PRISMA statement. All the studies were retrospective and cross-sectional studies written in English. The analyzed outcomes included lateral cephalometry (SNA, ANB, SN-PP, U1-PP), audible nasal air leakage, velopharyngeal insufficiency, hypernasality and anterior cross-bite. The results were analyzed using the Random effect model, represented as standardized mean difference (SMD) and Odds ratio (OR).The Risk of Bias was assessed by the ROBINS-I tool, while the level of evidence by GRADE analysis.
Results: From a total of 194 articles after our systematic search 17 studies with 885 patients were eligible for analysis. A statistically significant difference was found for the U1-PP, audible nasal air leakage and velopharyngeal insufficiency outcome, favoring the 1-stage approach (SMD 2.35 [0.18; 4.15]; OR 0.27 [0.07; 1.00]; OR 0.27 [0.08; 0.85], respectively). The statistical analysis of hypernasality showed a tendency towards lower odds, favoring the 1-stage method (OR 0.49 [0.17; 1.40]). For SNA, ANB, SN-PP and anterior cross-bite no superiority could be shown favoring one method over the other (SMD -0.28 [-1.32; 0.75]; SMD -0.4 [-1.26; 0.45]; SMD -0.31 [-1.59; 0.97]; SMD 1.40 [0.82; 2.41] respectively).
Conclusions: 1-stage palatoplasty provides better speech development ,while maxillofacial development does not differ substantially between 1-stage and 2-stage surgery. Thus the 1-stage method may serve as the first choice for operation unless obstacles appear in individual patients.