Master of Science
Active and passive pre-surgical orthopedic (PSO) devices are a controversial part of cleft palate management. There is no consensus as to the effects of these PSO devices on long-term outcomes and there is limited research comparing different PSO devices. The first objective of this research was to perform a systematic review of the literature surrounding the long-term effects of PSO device use. The second was to analyze and compare 10-year nasolabial aesthetic outcomes between patients treated with an active PSO device, passive PSO device, or no device. The final objective was to analyze and compare 10-year dental occlusion and facial growth in patients who received treatment with an active versus a passive PSO device. All patient data was assessed at 1, 5, and 10 years. Nasolabial aesthetics were assessed using patient photographs, dental occlusion was assessed using dental molds, and facial growth was assessed through cephalometric analysis. Systematic review identified 41 articles pertaining to long-term effects of PSO device use. This systematic review didn’t identify a consensus as to the effects of these devices but did identify that all 41 articles had methodologic flaws that limit the applicability of their results. Comparison of nasolabial aesthetics showed that patients treated with a PSO device have comparable aesthetics at the 10-year mark to patients treated with no device who have less severe alveolar gaps. Patients treated with active and passive devices have similar dental occlusion/arch development and facial growth up to 10 years.
Summary for Lay Audience
Patients with cleft lip and palate are often treated with a pre-surgical device prior to the surgical repair of their cleft lip. The role of this device is to help decrease the size of the gap in their palate, which in turn brings the edges of the lip closer together to facilitate the surgical repair of the lip. These devices can be active or passive. Active devices drive the edges of the cleft closer together with a pin and screw device, whereas passive devices gradually mold the cleft with a plate. The use of these devices is still controversial. The devices have been shown to improve patient outcomes but have also been shown to limit facial growth in these patients. In addition, there is very little research that has compared outcomes in patients depending on which type of device they received. The objectives of this study were to (1) review the research that has been done on these devices to see their long-term effects on patient outcomes, and (2) look at the long-term effects of these devices on facial aesthetics, dental occlusion (how the teeth fit together), and facial growth in a group of patients that have received treatment with these devices.
The literature review identified that research into the long-term effects of these devices is lacking. The research that does exist is limited by studies of poor quality. In addition, very few studies actually compared active and passive devices to see if one type of device is superior. Aesthetic outcomes for patients that received active or passive device treatment was similar between groups; aesthetics were comparable to patients with less severe clefts that did not require a device. Facial growth and dental occlusion were assessed at 5 and 10 years in patients with an active or a passive device. Dental occlusion and facial growth were both similar for patients treated with an active or a passive device up to 10 years of age.
Garland, Katie, "Growth and Development Analysis of Unilateral Cleft Palate Patients at One, Five, and Ten Years" (2020). Electronic Thesis and Dissertation Repository. 7358.
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