¿Son eficaces los conformadores nasales postoperatorios?: una revisión sistemática” / Are postoperative nasal conformers effective?: a systematic review

Introducción y objetivo: Lograr la simetría de labio y nariz es el objetivo de la reparación del labio leporino unilateral. Con este fin se han desarrollado diferentes tratamientos pre y postoperatorios. El objetivo de este estudio es realizar una revisión de la literatura para evaluar los efectos de los conformadores nasales postoperatorios en pacientes con labio y paladar hendido. Material y método: Llevamos a cabo una revisión sistemática de la literatura de los estudios publicados hasta marzo de 2021 para evaluar el efecto estético logrado usando conformadores nasales después de queilorrinoplastia primaria en pacientes con labio y paladar hendido. Resultados: Identificamos 6 estudios para la evaluación final, análisis que incluyó 195 pacientes. La calidad general del estudio según la escala Oxford CEBM y Newcastle-Ottawa fue baja Conclusiones: Los resultados obtenidos muestran que la colocación de conformadores nasales postoperatorios no mejoró la simetría nasal en pacientes con labio y paladar hendido unilateral. Según la evidencia científica disponible, no se pueden sacar conclusiones definitivas sobre la eficacia de estos dispositivos en la simetría nasal después de la reparación unilateral de labio hendido y fisura nasal. (AU)

Background and objective: Lip and nose symmetry are the goal of repair of unilateral cleft lip and different pre and postoperative treatments have been developed with this purpose. The objective of this study was to perform a review of the literature to evaluate the effects of postoperative nasal conformers on cleft lip and palate patients. Methods: We conduct a systematic review of the literature for studies published until March 2021 to evaluate aesthetic effect using nasal conformers after primary cheilorhinoplasty in patients with cleft lip and palate. Results: We identified 6 studies for the final analysis, which included 195 patients. The overall study quality according to Oxford CEBM and Newcastle-Ottawa scale was low. Conclusions: The results obtained from this study provides that placement of postoperative nasal conformers did not improve nasal symmetry in patients with unilateral cleft lip and palate. Based on available scientific evidence, definitive conclusions about the effectiveness of these devices on nasal symmetry after unilateral cleft lip nose repair cannot be drawn. (AU)

Is the Use of Opioids Safe after Primary Cleft Palate Repair? A Systematic Review.

Pharmacologic treatment of postoperative pain after cleft palate repair includes opioids and nonopioid analgesics, nerve blocks, and local anesthetic infiltration. Use of opioids in infants has concerns regarding sedation, risk of aspiration, respiratory depression, and respiratory distress. The main objective of this review was to analyze information available on the safety of the use of opioids during perioperative management of pain related to primary cleft palate repair in published studies. METHODS: A systematic review of the literature for studies published until March 2020 was performed to evaluate the safety of opioid drugs during primary cleft palate repair pain management. The authors chose the following MesH terms for this systematic review: cleft lip and palate AND opioids AND pain management. The investigators performed a systematic literature search using the Pubmed/MEDLINE, Embase, Web of Science, and Cochrane Library databases. RESULTS: After a literature search resulting in 70 identified studies, 9 were qualified for the final analysis, which included 772 patients. There was a high level of evidence in the selected studies according to the Oxford CEBM Level of Evidence classification and GRADE scale. The most common adverse event reported was postoperative nausea and vomiting (from 5% to 25%). Episodes of oxygen desaturation have been reported from 2.5% to 7.4% of the studied patients. CONCLUSION: s: Definitive conclusions about the safety of opioid drugs during primary cleft palate repair pain management cannot be drawn. Vomiting and oxygen desaturation have been associated with the use of opioids in the studied population.

Effect of Nonradical Intravelar Veloplasty in Patients With Unilateral Cleft Lip and Palate: A Comparative Study and Systematic Review.

BACKGROUND: The purpose of this study was to compare 2 techniques used for primary muscular repair and perform a systematic review of the literature to evaluate the effects of radical intravelar veloplasty (IVV) on nonsyndromic unilateral cleft lip and palate. METHODS: This is an ambispective study between 2 groups of patients with unilateral cleft lip and palate who were operated using a radical and conservative form of IVV in Lima Peru. Data collection was accomplished by evaluation of speech development and middle ear function of the patients. A systematic review of the literature for studies published until June 2020 to evaluate the effect using the radical IVV in patients with cleft lip and palate. RESULTS: Our comparative study did not find statistically significant differences in speech development between the studied techniques for unilateral cleft palate repair. Increased number of ear tube placements have been observed in the group treated with radical form of IVV. After systematic literature searching, 10 identified studies were qualified for the final analysis, which included 1367 patients. The overall study quality according to Oxford CEBM and GRADE scale was low. CONCLUSIONS: The results arising from this study provides statistical evidence that one technique let us obtain better speech outcomes. A technique with conservative IVV has statistical significant fewer rate of middle ear disorders after primary cleft palate repair. Based on available scientific evidence, definitive conclusions about the effectiveness of radical IVV on velopharyngeal and middle ear function cannot be drawn.