The Postoperative Stability And Evaluation Of Quality Of Life With Surgery-first Approach In Skeletal Classic Ⅲ Patients:A Systematic Review And Meta-analysis

Objective: To evaluate the postoperative stability and quality of life of patients with skeletal class Ⅲ malocclusion treated by surgery-first approach(SFA)and conventional three-stage method(CTM)basing on systematic review and meta-analysis,and to provide evidence-based medical evidence for the treatment of skeletal class Ⅲ malformations.Methods: The CNKI full-text database,Wanfang database,VIP journal database,China Biology Medicine database,PubMed,Embase,The Cochrane Library and Web of Science were searched.Literatures published before December 2019 on the postoperative stability and quality of life of the SFA for skeletal class Ⅲ malocclusion were collected and screened according to the inclusion and exclusion criteria.The quality of the included literatures was evaluated according to the NOS(Newcastle-Ottawa Scale)scale.The relapse in the horizontal and vertical directions of the B-point,Pogonion and A-point and orthognathic quality of life questionnaire(OQLQ)scores were selected as the outcome indicators to compare the postoperative stability and quality of life changes between the SFA group and the CTM group.The meta-analysis was performed using RevMan 5.3 and the sensitivity analysis and publication bias test were performed using Stata 14.0.Results: 16 studies are finally included with 594 participants which consists of 275 in SFA group and 319 in CTM group.(1)Horizontal stability: The relapse of B-point and Pogonion in the horizontal direction exists significant differences between SFA group and CTM group,but there is no significant difference in the relapse of A-point.(2)Vertical stability: The relapse of B-point and Pogonion in the horizontal direction exists significant differences between SFA group and CTM group,but there is no significant difference in the relapse of A-point.(3)Quality of life: SFA significantly improved the patients’ quality of life from early stage of treatment while CTM had a negative impact on the perception of the patients’ quality of life during decompensation phase。 Conclusion: Compared to CMT,the horizontal and vertical directions of the maxilla and the vertical direction of the mandible had similar stability after the operation with SFA.However,SFA showed poor stability of the mandible in the horizontal direction in postoperative treatment.Compared to CTM,SFA could improve the quality of life of treated patients after surgery earlier.