Does surgically assisted rapid maxillary expansion associated with pterygomaxillary disjunction result in changes in mandibular position? A PROSPERO-compliant systematic review of the literature

Evaluation of pterygomaxillary disjunction on skeletal and dental changes after surgically assisted rapid maxillary expansion: A systematic review and meta-analysis

Background

Surgically assisted rapid maxillary expansion (SARME) with disjunction of the pterygomaxillary suture is a procedure widely used in maxillofacial surgery. However, the pterygomaxillary disjunction (PD) procedure has often been deemed risky. The actual necessity and effectiveness of PD in SARME remain subjects of debate, with some studies suggesting that sufficient expansion can be achieved without it. This systematic review with meta-analysis aimed to evaluate the scientific literature regarding the effects of PD on skeletal and dental changes after SARME.

Methods

The systematic review followed the Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant articles published in different databases. The study conducted a comprehensive literature search across seven databases: PubMed/Medline, Web of Science, Science Direct, Scopus, Embase, Cochrane Collaboration Library, and Google Scholar. The selected studies evaluated the effect of the extent of expansion and the stability of SARME with PD, as well as the skeletal and dental changes associated with the treatment. The intervention cohorts within the sampled population chosen for incorporation into our analysis consisted of individuals who underwent SARME accompanied by PD, whereas the control group underwent SARME devoid of PD. Data were combined in a meta-analysis using the Review Manager 5.3.5. (RevMan) program. A systematic search was performed in seven databases (PubMed/Medline, Web of Science, Science Direct, Scopus, Embase, Cochrane Collaboration Library, and Google Scholar).

Results

After applying the selection criteria, seven articles were included in the systematic review, totaling 291 patients. Five articles were selected for meta-analysis. A meta-analysis was conducted to assess the effects of anterior and posterior dental expansions. After applying the selection criteria, seven articles were included in the systematic review, totaling 291 patients. Five articles were selected for meta-analysis. A meta-analysis was conducted to assess the effects of anterior and posterior dental expansions. Expansion in the previous region was slightly higher in the SARME with PD group compared to the PD-free group (95 % CI: 1.07 to 1.1 mm; p = 0.98). In the posterior region, expansion exceeding 0.11 mm was observed in the SARME with PD group compared to the PD-free group, but without statistical significance (95 % CI: 1.64 to 1.86 mm; p = 0.903).

Conclusion

SARME combined with PD proves to be an effective surgical procedure for correcting transverse maxillary deficiencies. However, no statistically significant differences were observed when SARME with and without PD was compared, indicating that SARME with PD can be used especially in cases that require expansion in the posterior region of the maxilla.

Surgically assisted maxillary expansion with or without pterygoid disjunction alters maxillomandibular positioning

PURPOSE

This study aimed to analyze alterations in mandibular positioning after surgically assisted maxillary expansion (SARME) with and without pterygoid disjunction (PD).

METHODS

Cone-beam computed tomography scans of 24 healthy individuals (18-45 years old) with transverse deficiency, superior to 5 mm, underwent SARME with or without PD. The aspects prospectively assessed were (1) alignment and position of the head (ITK-Snap and 3D Slicer software); (2) McNamara's and Steiner-Tweed-Wits' cephalometric analysis (Dolphin Imaging®); and (3) colorimetric evaluation based on 3D correspondence analysis (3D Slicer software).

RESULTS

A decrease in 1-NA and 1-SN angles as well as an increased occlusal plane in both groups was observed. Superior-inferior and anteroposterior spatial displacements of the chin were statistically significant in the PD group. Altered colorimetric patterns were also observed in the PD group.

CONCLUSIONS

This study found more evident tooth inclination in the group without PD; mandibular alterations were more evident in the PD group. Further studies with 3D analysis are strongly recommended for more comprehensive results.

Prevalence of malignant neoplastic oral lesions among children and adolescents: A systematic review and meta-analysis

BACKGROUND

Malignant neoplasms that affect children and adolescents are predominantly embryonic and generally affect blood system cells and supporting tissues.

AIM

This study aimed to summarize the scientific evidence about the prevalence of malignant lesions in the oral cavity of children and adolescents.

DESIGN

In this systematic review and meta-analysis (PROSPERO CRD42020158338), data were obtained from seven databases and the gray literature. Cross-sectional observational studies on the prevalence of biopsied oral pediatric malignancies were included. The Newcastle-Ottawa Scale assessed the quality of the included studies, and the GRADE approach evaluated the evidence certainty. The meta-analysis prevalence was calculated using MedCalc® software, adopting a 95% confidence level (CI; random-effect model).

RESULTS

Forty-two studies were included in the meta-analysis. Of the 64,522 biopsies, the prevalence of malignant lesions was 1.93% (n = 1,100; 95% CI = 1.21%-2.80%). Countries with a low socioeconomic profile showed the highest prevalence. The sample size did not influence the prevalence of oral malignancies, and unspecified lymphomas (12.08%; 95% CI = 5.73%-20.37%) and rhabdomyosarcoma (10.53%; 95% CI = 7.28%-14.30%) were the most common lesions.

CONCLUSIONS

Oral malignant lesions biopsied in children and adolescents had a prevalence of <3%, and lymphomas and sarcomas were the most prevalent lesions.

Effect of maxillary advancement on speech and velopharyngeal function of patients with cleft palate: Systematic Review and Meta-Analysis

This systematic review (SR) aimed to evaluate speech and velopharyngeal function (VPF) changes of patients with cleft palate (CLP) after maxillary advancement (MA) surgery. A two-phase PROSPERO-registered SR (CRD42019141370) was conducted following the PRISMA statements. Search strategies were developed for main databases (PubMed, Scopus, Web of Science, COCHRANE, LILACS, and EBSCOhost) and Grey literature information sources. The GRADE tool was used to evaluate the quality of evidence. From a total of 908 articles, 10 (205 men and 147 women; mean age ranging from 18.0 to 25.7 years) were selected for meta-analysis. Moderate to high risk of bias (Rob) was observed. The most common methods for outcomes evaluation were the Nasometer (speech) and nasoendoscopy (VPF). Speech changed from normal to hypernasal, and VPF worsening were reported in most studies. Comparing maxillary advancement interventions (osteogenic distraction versus Le Fort I), no statistically significant differences were found regarding benefit on speech and VPF. In summary, the effect of MA on speech and VPF remains controversial in CLP patients. The RoB, inconsistencies, and imprecisions severely affected the overall quality of evidence. Further adequately delineated clinical studies are necessary to investigate the potential effect of MA interventions on speech and VPF in CLP patients.