The effect of facemask in patients with unilateral cleft lip and palate: a systematic review and meta-analysis

Abstract

Summary Background Patients with cleft lip and palate usually present a Class III skeletal pattern. Facemask (FM) is one of the conventional orthodontic treatment modalities used to address the skeletal discrepancy in cleft patients. Objective To investigate the potential effectiveness of FM in unilateral cleft lip and palate (UCLP) patients. Search methods Search without restrictions except language in seven databases since inception and hand searching until January 2019 was conducted. Detailed search strategies were developed for each database which were based on the PubMed strategy and adapted accordingly. Selection criteria Controlled studies assessing the effect of FM in UCLP patients were to be included. Data collection and analysis After retrieval and selection of the studies, data extraction was performed. Both angular and linear cephalometric measurements were collected. Weighted mean differences (WMDs) and 95% confidence intervals (CΙs) between treated and untreated UCLP patients concerning the pre- and post-treatment angular measurements of each group were calculated using a random-effects meta-analysis model. The risk of bias in individual studies was assessed using the ROBINS-I tool. Results From nine eligible studies, five were included in the meta-analysis investigating the use of FM in patients and controls with UCLP (with and without maxillary expansion). Statistically significant differences were evident for SNA/S–N–ss, SNB/S–N–sm, ANB/ss–N–sm, and SN–MP. FM was found to induce an increase of SNA (WMD = 2.12 degrees, 95% CI: 1.58 to 2.66), ANB (WMD = 4.17 degrees, 95% CI: 3.60 to 4.74), and SN–MP angles (WMD = 2.60 degrees, 95% CI: 1.10 to 4.10) and a decrease of SNB angle (WMD = −1.94 degrees, 95% CI: −2.48 to −1.40) in UCLP patients. Low to moderate heterogeneity was observed. Limitations They emerge due to risk of bias, exclusion of non-English papers and methodological characteristics of the included papers. Conclusions According to the available data, FM seems to improve the sagittal skeletal relationships in UCLP patients, increasing the SNA and ANB angles and decreasing the SNB angle. Moreover, in the vertical dimension, FM increases the SN–MP angle. Regarding dental measurements, there are controversial results. More high-quality studies need to be conducted in order to further clarify the impact of FM on UCLP patients. Registration number PROSPERO: CRD42019131619.

Efficacy of Different Methods of Bone-Anchored Maxillary Protraction in Cleft Lip and Palate Children: A Systematic Review and Meta-Analysis

“…Compared with Palikaraki et al's study, 20 the current systematic review, which investigated the effects of BAMP treatment on all developing patients with unilateral and bilateral cleft lip and palate in the related articles, indicated that the SNA and ANB exclusively showed a significant positive difference in support of treatment, and SNB and SN-MP indicated only marginally different values.…”

“…In the systematic review and meta-analysis of Palikaraki et al's study in 2021, 20 the effects of the tooth-born facemask on patients with unilateral cleft lip/palate was examined. A statistically significant difference was established in the values of the landmarks SNA, SNB, ANB, and SN-MP between before and after the treatment phases.…”

Protraction Headgear Compliance and Orthognathic Surgery in Patients With Cleft Lip and Palate

“…Palikaraki et al reports similar skeletal responses to PHG among patients with UCLP with or without expansion and showed approximately 2° improvements in SNA and SNB, 4° change in ANB, and 2° increase in MPA. 28 These changes are in concordance with short-term effects of PHG in young patients without CLP. 16 Proclination of the upper incisors is also significant post-PHG in both our sample and in the literature for patients with and without CLP.…”

Miniplate‐anchored maxillary protraction in adolescent patients with cleft lip and palate: A literature review of study design, type and protocol, and treatment outcomes

“…In this review, skeletal Class III relationship was effectively corrected by the advancement of A point regardless of the MAMP type (range of ΔSNA, 0.5°-4.2° in type 1; 1.2°-1.7° in type 2; range of ΔANB, 0.6°-3.0° in type 1, and 1.0°-3.5° in type 2; Table 1), which was similar to the results from a recent meta-analysis of MAMP in non-cleft patients 24 and conventional facemask treatment in cleft patients. 25 Therefore, it can be stated that the sagittal skeletal discrepancy in the maxillomandibular complex was corrected primarily by maxillary advancement rather than mandibular repositioning in MAMP therapy.…”