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Cornefjord M, Arnebrant K, Guné H, Holst J, Klintö K, Stiernman M, Svensson H, Wiedel AP, Becker M. A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate. J Plast Surg Hand Surg 2023; 58:132-141. [PMID: 38095226 DOI: 10.2340/jphs.v58.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023]
Abstract
The aim of this systematic review was to determine whether one-stage palatoplasty for children born with cleft lip and palate shows overall advantages in outcome compared with two-stage palatoplasty. The included studies were controlled studies of syndromic and non-syndromic children born with unilateral cleft lip and palate, bilateral cleft lip and palate, or isolated cleft palate. The interventions studied were one-stage palatoplasty and two-stage palatoplasty starting with the soft palate. The outcomes were facial growth, speech, hearing, presence of fistulae, other complications related to surgery, health-related quality of life, and health economics. In total, 14 original studies were included. Results were dichotomized into showing advantage for one- or two-stage palatoplasty for the respective outcome and compared with the results from six included systematic reviews. No overall advantage for either surgical strategy was found for any of the outcome measures. The certainty of evidence was highest for the presence of fistulae, followed by facial growth and speech. For several outcomes, the quality of the existing evidence was too low to allow for any conclusions to be drawn. Neither one- nor two-stage palatoplasty showed significant advantages in clinical outcomes compared with the other. Other aspects such as ethics, economics, or surgeon's preference might hence be of more importance. Homogenous choices of outcome measures and defined minimal clinically important differences would facilitate further research.
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Affiliation(s)
- Måns Cornefjord
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences in Malmö, Lund University, Sweden.
| | - Kristina Arnebrant
- Department of HTA Studies South, Skåne University Hospital, Lund, Sweden
| | - Henrik Guné
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Jan Holst
- Department of HTA Studies South, Skåne University Hospital, Lund, Sweden; Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Kristina Klintö
- Division of Speech Language Pathology, Department of Otorhinolaryngology, Division of Speech and Language Pathology, Skåne University Hospital, Malmö, Sweden; Division of Speech Language Pathology, Phoniatrics and Audiology, Department of Clinical Sciences in Lund, Lund University, Sweden
| | - Mia Stiernman
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Henry Svensson
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Anna-Paulina Wiedel
- Department of Clinical Sciences in Malmö, Lund University, Sweden; Department of Oral and Maxillofacial Surgery, Skåne University Hospital, Malmö, Sweden
| | - Magnus Becker
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences in Malmö, Lund University, Sweden
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