The Effectiveness Of Preoperative Correction Techniques In Improving Nasal Deformity In Infant With Unilateral Complete Cleft Lipand Palate: A Systematic Review And Meta-analysis

Objective: Unilateral complete cleft lip and palate(UCCLP)is associated with apparent nasal deformities before the Cheilorrhaphy.The aim of this study was to determine whether preoperative correction techniques are effective in the treatment of nasal deformities in infant with unilateral complete cleft lip and palate used by the systematic review and meta-analysis.Methods: We used subject words and free words to determine the key words(("cleft lip" OR "cleft palate" OR "cleft lip and palate")AND(("Preoperative" or "presurgical")AND("correction" or "appliance" or "nasoalveolar molding")or PNAM)),and used to retrieve all documents as of January 31,2019 by means of combination of computer retrieval and manual retrieval in MEDLINE,Cochrane Library,EMBASE,Pub Med and CBM(Chinese biomedical literature database)database,regardless oflanguage and publication status.Two investigators independently screened articles according to the established inclusion and exclusion criteria,conducted data extraction and quality assessment.And used Revman 5.3software for data analysis.The outcome measures selected in this study included the height of nasal columella,the width of the affected side nasal ala and the inclination of the nasal columella.Results: Seven articles were incorporated into the systematic review,and five(274 participants)in the meta-analysis according to the inclusion criteria.The results showed that for patients with UCCLP,preoperative correction can not only increase the height of nasal columella(SMD:2.64 mm,95%CI: [1.35 mm,3.94mm],P<0.0001),but also significantly reduce the width of the affected side nasal ala(SMD:-5.14 mm,95%CI:[-8.96 mm,-1.13mm],P<0.008).However,there is insufficient evidence for improving the inclination of nasal columella(SMD:-3.48 degrees,95%CI:[-7.56 degrees,0.59 degrees],P=0.09).Conclusions: Preoperative correction for children with UCCLP can increase the height of nasal columella,reduce the width of the affected side nasal ala,improve the nasal symmetry,and reduce nasal deformity.However,no significant effect could be observed for the inclination of the nasal columella.