Effects of various surgical protocols on maxillofacial growth in patients with unilateral cleft lip and palate: a systematic review

Aim: The purpose of this study was to ascertain the effect of surgical procedures and their timing on maxillofacial growth in unilateral cleft lip and palate (UCLP) patients through a systematic literature review.Methods: In December 2019, a search was conducted in PubMed and Web of Science on the basis of the keywords: “UCLP”, “maxillofacial growth” and “facial growth”, complemented by a hand search.Results: Eleven articles were included. An important finding was the wide range of treatment protocols. Eight studies performed a multistage procedure, whereas three studies applied a simultaneous repair of cleft lip, palate, and alveolus in a single surgical session. The findings in these articles were based on cephalometric measures. Comparative tables were constructed regarding method of study and time and technique of closure.Conclusion: The results of the articles were conflicting, and it was clear that more research on this subject is necessary. Overall, most studies agreed on the important factor of palatoplasty in maxillofacial growth. The most common finding was a retrusive maxillary growth in comparison to a noncleft control group. This was illustrated by a negative effect on A-point - nasion - B-point. A lot of discussion remains on the effect of lip closure. However, most studies seemed to agree that lip closure results in retro-inclined upper incisors. In conclusion, it is essential that an agreement be reached on the treatment for UCLP, since this is the most common congenital craniofacial condition