Long-term outcomes of simplified gingivoperiosteoplasty performed at the time of hard palatal closure: A review of 55 alveolar clefts

Han, Kihwan; Park, Jungheum; Choi, Ji Suk; Son, Daegu

doi:10.1016/j.bjps.2016.08.003

Cited by 9 publications

(13 citation statements)

References 18 publications

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“…Twenty-four articles were excluded (Online Appendix B). Two articles were case reports (Berkowitz, 1996; Hellquist, 1971), 4 articles had no adequate control group (Hellquist and Skoog, 1976; Hellquist and Ponten, 1979; Hellquist et al, 1983; Han et al, 2016), 1 study had both GPP and SBG done in the same group (Lee et al, 2004), 4 studies compared data from different centers (Henkel and Gundlach, 2002; Flinn et al, 2006; Grisius et al, 2006; Zemann et al, 2007), 7 articles didn’t report the outcomes of interest (Hellquist et al, 1979; Millard et al, 1999; Pfeifer et al, 2002; Chan et al, 2003; Berkowitz et al, 2004; Renkielska et al, 2005; Wojtaszek-Slominska et al, 2010), and 2 articles did not have GPP performed in their intervention group (Larson et al, 1983; Tan et al, 2015). One study had no available full-text article (Yee et al, 2014), 2 studies had pooled results for unilateral and bilateral cases (Santiago et al, 1998; Sato et al, 2008), and 1 study was a duplicate (Henkel and Gundlach, 1998).…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of Gingivoperiosteoplasty on Alveolar Bone Reconstruction and Facial Growth in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis

El-Ashmawi

Elkordy

Fayed

et al. 2018

The Cleft Palate Craniofacial Journal

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Objective: The aim of the systematic review is to evaluate the effects of gingivoperiosteoplasty (GPP) on alveolar bone quality and facial growth in patients with cleft lip and palate (CLP). Search Methods: Electronic and manual search was done up to October 2017. Eligibility Criteria: Clinical and observational studies that compared GPP to control; patients without GPP evaluated either before or after the age for secondary bone graft (SBG). Data Collection and Analysis: Studies selection was done by 2 authors independently. Risk ratio and mean difference with 95% confidence intervals (CIs) were calculated using random-effects models. Results: Thirteen articles were included in the review. All studies were at high risk of bias. Poorer alveolar bone quality was found in the GPP group compared to the SBG group. The pooled data showed a statistically significant increase in the incidence of Bergland type III in the GPP group compared to SBG (risk ratio: 11.51, 95% CI: 3.39-35.15). As for facial growth, GPP group resulted in a more retruded maxillary position (as indicated by “Sella-Nasion-Subspinale” angle [SNA value]) compared to control group by −1.36 (CI: −4.21 to 1.49) and −1.66 (CI: −2.48 to −0.84) when evaluated at 5 and 10 years, respectively. The protocol for presurgical infant orthopedics used in conjunction with the GPP procedure might have affected the results of the alveolar bone and facial growth outcomes. Conclusions: Definitive conclusions about the effectiveness of GPP cannot be drawn. Very weak evidence indicated that GPP might not be an efficient method for alveolar bone reconstruction for patients with unilateral and bilateral CLP. Gingivoperiosteoplasty surgery could lead to maxillary growth inhibition in patients with CLP.

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Section: Resultsmentioning

confidence: 99%

Effectiveness of Gingivoperiosteoplasty on Alveolar Bone Reconstruction and Facial Growth in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis

El-Ashmawi

Elkordy

Fayed

et al. 2018

The Cleft Palate Craniofacial Journal

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“…Supporters of nasoalveolar molding cite statistically significant improvements in nasal symmetry in patients who undergo the treatment compared with those who do not, 4,5 benefit to nasal aesthetics as judged by caregivers and surgeons, 6,7 greater benefit to columellar length in patients with bilateral cleft lip, 8–10 cost benefit compared with lip adhesion, 11 decreased need for revision surgery on the nose, 9,12 psychosocial benefit to caregivers, 6,7 and the opportunity for primary alveolar reconstruction in the form of gingivoperiosteoplasty, which can avoid secondary alveolar bone grafting procedures in 51 percent to 72 percent of patients. 13–16 Furthermore, cleft centers accredited by the American Cleft Palate–Craniofacial Association are utilizing nasoalveolar molding in an increasing trend, with 37 percent of centers using it in 2012 17 and 43 percent using it in 2019. 18…”

mentioning

confidence: 99%

“…grafting procedures in 51 percent to 72 percent of patients. [13][14][15][16] Furthermore, cleft centers accredited by the American Cleft Palate-Craniofacial Association are utilizing nasoalveolar molding in an increasing trend, with 37 percent of centers using it in 2012 17 and 43 percent using it in 2019. 18 Opponents of nasoalveolar molding report poor caregiver compliance, 19,20 limited or no effect of therapy, 21,22 disruption of facial growth, 23,24 and the lack of high-level supportive scientific evidence.…”

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confidence: 99%

The Nasoalveolar Molding Cleft Protocol: Long-Term Treatment Outcomes from Birth to Facial Maturity

Yarholar¹,

Shen²,

Wangsrimongkol³

et al. 2021

Plastic &Amp; Reconstructive Surgery

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left lip and palate are the most common congenital anomaly of the face. Although the optimal indications and treatment protocols continue to be debated, one of the most actively discussed therapies is nasoalveolar molding. [1][2][3] Supporters of nasoalveolar molding cite statistically significant improvements in nasal symmetry in patients who undergo the treatment compared with those who do not, 4,5 benefit to nasal aesthetics as judged by caregivers and surgeons, 6,7 greater benefit to columellar length in patients with bilateral cleft lip, 8-10 cost benefit compared with lip adhesion, 11 decreased need for revision surgery on the nose, 9,12 psychosocial benefit to caregivers, 6,7 and the opportunity for primary alveolar reconstruction in the form of gingivoperiosteoplasty, which can avoid secondary alveolar bone

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“…13,14 Pre and postoperative management of these cleft patients must also include a multidisciplinary team consisting of an otolaryngologist, an orthodontist, and a speech therapist. 10 Although the prime answer to the care of the cleft patient is surgery some techniques that may improve the surgical outcomes are done in infancy like presurgical nasal-alveolar molding (NAM). 15 Despite effective and meticulous cleft palate repair the rates of development of palatal fistula are high and affects negatively on the patients' general health and quality of life due to the presence of symptoms like nasal regurgitation, poor oral hygiene, and nasal emission during speech.…”

Section: Discussionmentioning

confidence: 99%

“…9 Various technical modifications are in practice to avoid this dreaded complication. 10 In a Study, Losquardo et al 7 described a regimen of performing gingivoperiosteoplasty at 12 months with palatal repair and reported good outcomes in terms of reduction or elimination for secondary bone graft and decreases the incidence of anterior fistula following palatal repair.…”

Section: Introductionmentioning

confidence: 99%

A novel technique for prevention of anterior fistula and facilitation of alveolar cleft repair: Gingivoperiosteoplasty with palatoplasty

Ahmed

Yasmeen²,

Khan³

et al. 2022

Pak J Med Sci

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Background & Objectives: The Cleft palate is one the most commonly encountered congenital deformity in plastic surgery clinics and can be associated with cleft lip and alveolus. Though palate repair can be associated with several complications, the most frequent and troublesome is anterior fistula formation. Various technical modifications are in practice to avoid this dreaded complication. We have started combining gingivoperiosteoplasty with palate repair to avoid postoperative anterior fistula formation and to close alveolar cleft at the same time. Methods: A prospective study was performed at the department of plastic and reconstructive surgery, Liaquat National Hospital, Karachi and selected patients were enrolled in the study after informed consent. A total of 15 patients were operated on from January 2017 to December 2020. All patients had cleft palate repair along with primary gingivoperiosteoplasty (GPP) at the age of standard palatal repair. Buccal/oral and nasal layers of the alveolus were dissected as per standard gingivoperiosteoplasty and repaired in continuation with nasal and oral layers of the palate. Postoperatively, the standard cleft palate repair protocol was followed. Follow-up was done at four weeks, 12 weeks, and six months and repair integrity was checked. Future follow-up at 4-5 years of age is planned to see the effect on alveolar collapse, bone growth, and the need for secondary bone grafting. Results: All patients were followed up regularly. None had a complication of fistula. The repairs of both palate and alveolus remained intact. Patients were kept on the follow-up to assess the need for alveolar bone grafting in the future. Conclusion: Gingivoperiosteoplasty combined with the palatal repair is a novel technique for the prevention of anterior palatal fistula. doi: https://doi.org/10.12669/pjms.38.7.5422 How to cite this:Ahmed O, Yasmeen S, Khan MI, Beg MSA. A novel technique for prevention of anterior fistula and facilitation of alveolar cleft repair: Gingivoperiosteoplasty with palatoplasty. Pak J Med Sci. 2022;38(7):1816-1820. doi: https://doi.org/10.12669/pjms.38.7.5422 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Long-term outcomes of simplified gingivoperiosteoplasty performed at the time of hard palatal closure: A review of 55 alveolar clefts

Cited by 9 publications

References 18 publications

Effectiveness of Gingivoperiosteoplasty on Alveolar Bone Reconstruction and Facial Growth in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis

Effectiveness of Gingivoperiosteoplasty on Alveolar Bone Reconstruction and Facial Growth in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis

The Nasoalveolar Molding Cleft Protocol: Long-Term Treatment Outcomes from Birth to Facial Maturity

A novel technique for prevention of anterior fistula and facilitation of alveolar cleft repair: Gingivoperiosteoplasty with palatoplasty

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