One-stage and Two-stage Palatoplasty and Dental Arch Width Outcome: A Systematic Review and Meta-Analysis
Keywords:
Palatoplasty, Dental arch width, Maxillary hypoplasia, Systematic review, Meta-analysisAbstract
Background : Palatoplasty for cleft palate patients are mostly remain complications. Patients have high risk to be under secondary operations and/or orthodontics treatment. Many researchers try to find for standard surgical techniques or appropriate timing that could have resulted in satisfaction in many aspects among all disciplines involved.
Objective : The purpose of this systematic review and meta-analysis was to quantitatively find out whether variety of palatoplasty techniques have effect on the facial growth, development of maxillary arch especially transverse dental arch width.
Method : PubMed database was systematically searched for related articles, together with searching in Biomed Central, Open Access, Google scholar and hand search. They were all filtered for articles in English from 1970 until 2019. Seven articles were accepted and 7-8 datasets extracted. Comparison of One-stage and Two-stage palatoplasty by inter canine arch width (IC), inter tuberocity/ molar arch width (IT) were calculated for standard mean difference (SMD) at 95% CI and ramdom effect model were used.
Result : The result shows that the IC of two-stage technique is slightly wider than one-stage technique (SMD = 0.050; 95% CI -0.505, 0.604; p = 0.861). The IT of two-stage technique is slightly narrower than one-stage technique (SMD = -0.018; 95% CI -0.540, 0.505; p = 0.987). Both have no statisticaly significant. Due to the hight heterogeneity of data (I2 = 77.7% and 78.7%) and wide range of CI, subgroup analysis were done between the measurement <5 years and >5 years of ages. The heterogeneity remain high but only the inter canine arch width of <5 years has a decrease value of I2 (I2 = 63.6%).
Conclusion : One-stage and Two-stage palatoplasty have small diffences, no statistically significance. The results evidence suggests that high inconsistency were noted in both groups. The reason for heterogeneity remains obscure. However, the validity of the evidence is limited and further high-quality trials are needed.
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