Changes in Airway Dimensions After Face-Mask Therapy in Cleft Lip and Palate and Non-cleft Patients: Systematic Review and Meta-Analysis

Abstract

Context: Maxillary deficiency can lead to the reduction of airway space and increase the chances of development of obstructive airway disorders. Facemask therapy is one of the main treatment protocols in developing maxillary deficient patients. Objectives: The purpose of this systematic review and meta-analysis was to assess the changes in the airway dimensions after face-mask therapy in both cleft lip and palate and non-cleft patients. Data Sources: A systematic search in different electronic databases (EMBASE, Pubmed, Cochrance Central register of controlled trials), IADR proceedings and a hand search by October 2020 were conducted and a meta-analysis and systematic review was performed. Results: In patients without cleft lip and palate, upper pharyngeal width was significantly increased by mean of 2.05mm (CI = 95%, 0.61 - 3.50) following facemask therapy in comparison to patients who did not receive the treatment.Other upper pharyngeal (nasopharyngeal) measurements also showed a statistically significant improvement after therapy: S-PNS by 4.64mm (CI = 95%, 3.34 - 5.94), AD1-PNS by 3.81 mm (CI = 95%, 2.40 - 5.21), AD2-PNS by 2.90 mm (CI = 95%, 0.13 - 5.67) and Pm’-SPL by 2.53 (CI = 95%, 0.54 - 4.51). Lower pharyngeal measurments did not show any significant changes after the treatment (P > 0.05).In the analysis of studies with 3D imaging modalities, upper pharyngeal volume was also significantly increased by 499.29mm3 (CI = 95%, 69.58-929.00) after the treatment. In addition, a review of articles that included cleft lip and palate patients also showed after the treatment, the upper pharyngeal measurements all showed a significant improvement (P < 0.05), whereas the oropharyngeal region was relatively stable. Conclusions: In maxillary deficient patients with or without an orofacial cleft, facemask therapy can improve the nasopharyngeal area dimensions; however, this treatment protocol appears not to have an effect on the oropharyngeal area of the airway tract.

Long-Term Stability of Alveolar Bone Graft in Cleft Lip and Palate Patients: Systematic Review and Meta-Analysis

“…The management of cleft lip and palate patients requires a multidisciplinary approach that includes surgical and nonsurgical treatments. 8,9 The goal of surgical interventions in the treatment of cleft lip and palate is to restore morphology and function without impairing growth potential. Secondary alveolar bone grafting is one of the main challenges during orthodontic treatment and surgery of patients with cleft lip and palate.…”

“…1 The benefits of alveolar bone grafting include integrating maxillary segments and helping to create a uniform alveolar ridge, supporting and assisting bone growth in adjacent teeth, an opportunity for rapid maxillary suture expansion, permitting orthodontic tooth alignment, allowing placement of osseointegrated implants, removal of oronasal fistula, and improving alar base symmetry, lip support, and facial esthetics. [1][2][3][9][10][11][12] Alveolar bone grafting can be performed at various ages based on the patient's age or dental development. There are 2 categories in this regard: primary bone graft and secondary bone graft.…”

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However, only the lower midfacial area can be advanced, and it is impossible to resolve the overall midface deficiency due to the position of the Le Fort I osteotomy line. 5,9 Thus, facial implant placement can be considered because the upper-midface deficiency cannot be resolved through Le Fort I osteotomy.Various types of prosthesis, including silicone (polydimethylsiloxane), GoreTex (expanded polytetrafluorethylene, WL Gore & Associates Inc, Flagstaff, AZ), and MedPor (high-density porous polyethylene, Porex Industries, Fairburn, GA), have been used to alleviate facial depression. Since these prostheses are supplied by sizes, premanufactured prostheses of an appropriate size should be selected during the surgery and need to be carved before placing them.

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“…However, only the lower midfacial area can be advanced, and it is impossible to resolve the overall midface deficiency due to the position of the Le Fort I osteotomy line. 5,9 Thus, facial implant placement can be considered because the upper-midface deficiency cannot be resolved through Le Fort I osteotomy.…”

“…The management of cleft lip and palate patients requires a multidisciplinary approach that includes surgical and nonsurgical treatments 8,9 . The goal of surgical interventions in the treatment of cleft lip and palate is to restore morphology and function without impairing growth potential.…”