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.
DESIGN: A descriptive cross-sectional multicenter study based on a study questionnaire was conducted of parents of patients with cleft lip and/or palate.
SETTING: Three centers providing cleft care from different regions in Malaysia: the national capital of Kuala Lumpur, east coast of peninsular Malaysia, and East Malaysia on the island of Borneo.
PARTICIPANTS: Parents/primary caregivers of patients with cleft lip and/or palate.
RESULTS: There were 295 respondents from different ethnic groups: Malays (58.3%), indigenous Sabah (30.5%), Chinese (7.1%), Indian (2.4%), and indigenous Peninsular Malaysia and Sarawak (1.7%). Malay participants reported that attributing causes of cleft to God's will, superstitious beliefs that the child's father went fishing when the mother was pregnant or inheritance. Sabahans parents reported that clefts are caused by maternal antenatal trauma, fruit picking, or carpentry. The Chinese attribute clefts to cleaning house drains, sewing, or using scissors. Cultural background was reported by 98.3% of participants to pose no barrier in cleft treatment. Those from lower socioeconomic and educational backgrounds were more likely to encounter difficulties while receiving treatment, which included financial constraints and transportation barriers.
CONCLUSION: There is a wide range of cultural beliefs in the multiethnic society of Malaysia. These beliefs do not prevent treatment for children with cleft. However, they face challenges while receiving cleft treatment, particularly financial constraints and transportation barriers. Such barriers are more likely experienced by parents from lower income and lower education backgrounds.
METHODS: Dental models of 84 subjects were taken before orthodontic treatment and alveolar bone grafting. The mean age was 7.69 (SD 2.46) years. The DAR and PM were assessed blindly by five raters using the EUROCRAN index (EI). Kappa statistics was used to evaluate the intra- and inter-examiner agreement, chi square was used to assess the associations, and logistic regression analysis was used to explore the responsible factors that affect DAR and PM.
RESULTS: The mean EUROCRAN scores were 2.44 and 1.93 for DAR and PM, respectively. Intra- and inter-examiner agreement was moderate to very good. Using crude and stepwise backward regression analyses, significant associations were found between the modified Millard technique (P = 0.047, P = 0.034 respectively) of cheiloplasty and unfavorable DAR. Complete UCLP (P = 0.017) was also significantly correlated with unfavorable DAR. The PM showed a significant association with the type of cleft, type of cheiloplasty and type of palatoplasty.
CONCLUSION: This multivariate study determined that the complete type of UCLP and the modified Millard technique of cheiloplasty had significantly unfavorable effects on both the DAR and PM.