Clinical Practice Guidelines for the Management of Patients With Cleft Lip and Palate: A Systematic Quality Appraisal Using the Appraisal of Guidelines for Research and Evaluation II Instrument

Abstract

Patients with cleft lip and/or palate require complex and longitudinal care by a multidisciplinary cleft team. Unfortunately, delivery of cleft care is often fragmented, and care practices can vary significantly. Multiple clinical practice guidelines (CPGs) have been proposed to provide a standardized framework for cleft care delivery. As CPGs have gained popularity, there has been increasing demand to maintain the quality of existing guidelines. A comprehensive search of EMBASE, MEDLINE via PubMed, Scopus, Cochrane and grey literature sources published from January 1, 1990 to December 31, 2020 was conducted to identify CPGs for the care of cleft patients. The Appraisal of Guidelines for Research and Evaluation, 2nd edition II tool was used to assess the quality of selected CPGs. Intraclass coefficients were calculated to assess agreement among appraisers. Eleven guidelines were identified for study inclusion. One guideline was classified as ''high'' quality by Appraisal of Guidelines for Research and Evaluation II criteria, and the remaining guidelines were classified as ''average'' or ''low'' quality. The ''Clarity of Presentation'' domain achieved the highest mean score (76.9% AE 11.7%) across CPGs, whereas the ''Rigor of Development'' domain scored the lowest (35.6% AE 21.2%). Intraclass coefficients analysis reflected very good inter-rater reliability across all domains (0.853-0.987). These findings highlight significant variability in the quality of existing CPGs for the global management of patients with cleft lip and/or palate. The ''Rigor of Development'' domain reflects the greatest opportunity for improvement. Given these findings, future guidelines may prioritize incorporating a systematic review of existing evidence into recommendations.

Alveolar Bone Grafting in Unilateral Cleft Lip and Palate: Impact of Timing on Palatal Shape

“…Alveolar bone grafting, like any surgical procedure conducted in a growing child, has the potential to affect the natural growth and development of the maxilla and its surrounding structures [24,25]. To mitigate this interference, it is generally recommended to postpone the grafting until most maxillary growth has occurred [26][27][28]. As a result, most cleft centers perform ABG when the child's permanent canine at the cleft side starts to erupt, which typically happens between the ages of 9 and 11 years.…”