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Published on: September 19, 2015
A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate
Måns Cornefjord1, Kristina Arnebrant2, Henrik Guné3
1Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences in Malmö, Lund University, Sweden. mans.cornefjord@med.lu.se.
Insights
This systematic review found no overall advantage for one-stage versus two-stage palatoplasty in children with cleft lip and palate. Clinical outcomes like speech and facial growth showed no significant differences between the surgical approaches.
Area of Science:
- Craniofacial Surgery
- Pediatric Plastic Surgery
- Systematic Review and Meta-Analysis
Background:
- Cleft lip and palate repair involves complex surgical techniques.
- The choice between one-stage and two-stage palatoplasty is a critical decision in pediatric care.
- Understanding the comparative outcomes of these approaches is essential for optimizing patient care.
Approach:
- Systematic review of 14 controlled studies on syndromic and non-syndromic children with cleft lip and palate.
- Interventions compared: one-stage palatoplasty versus two-stage palatoplasty (starting with soft palate).
- Outcomes assessed: facial growth, speech, hearing, fistulae, surgical complications, quality of life, and health economics.
Key Points:
- No overall advantage identified for either one-stage or two-stage palatoplasty across all outcome measures.
- Certainty of evidence was highest for fistulae presence, facial growth, and speech outcomes.
- Evidence quality was too low for definitive conclusions on several other outcomes.
Conclusions:
- Neither one-stage nor two-stage palatoplasty demonstrated significant clinical advantages over the other.
- Factors beyond clinical outcomes, such as ethics, economics, or surgeon preference, may influence surgical strategy.
- Standardized outcome measures and minimal clinically important differences are needed to advance future research in this area.
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.
