Pterygomaxillary Disjunction and its Influence on the Result of Surgically Assisted Maxillary Expansion: A Systematic Review and Meta-analysis
Bruno da Silva Mesquita, Belmiro Cavalcanti do Egito Vasconcelos, Sandra Lucia Dantas de Moraes, Cleidiel Aparecido Araújo Lemos, Jéssica Marcela de Luna Gomes, Eduardo Piza Pellizzer, Emanuel Sávio de Souza Andrade
Citation Information :
Mesquita BD, Vasconcelos BC, de Moraes SL, Lemos CA, Gomes JM, Pellizzer EP, Andrade ES. Pterygomaxillary Disjunction and its Influence on the Result of Surgically Assisted Maxillary Expansion: A Systematic Review and Meta-analysis. J Contemp Dent Pract 2020; 21 (6):696-700.
Aim: The aim of this study was to evaluate the available evidence to identify the influence of pterygomaxillary disjunction on the result of surgically assisted maxillary expansion. Background: LeFort I type osteotomy with disjunction of the pterygomaxillary suture is a procedure widely used in maxillofacial surgery. However, the need for its performance during surgically assisted maxillary expansions has been discussed in literature, since serious complications can be caused during this stage. Review results: Systematic review of articles was performed using three databases (PubMed, Web of Science, and Cochrane) published until May 2019. After applying the selection criteria, five articles were included in the systematic review, with a total of 141 patients. Meta-analysis showed the absence of significant difference between intervention and control groups in the preoperative period (standardized mean difference = −0.28; confidence interval, CI 95% = −0.81, 0.26; p = 0.31) and postoperative period (standardized mean difference = −0.12; 95% CI = −0.65, 0.42; p = 0.66). In general, the heterogeneity of statistical estimates was low (I2 = 0%). Conclusion: No statistically significant difference was observed between control group (without pterygomaxillary disjunction) and intervention group (with pterygomaxillary disjunction). Clinical significance: Based on the data analyzed in this systematic review, it could be concluded that pterygomaxillary disjunction is not a mandatory step to achieve satisfactory maxillary expansion. Thus, not performing pterygomaxillary disjunction can prevent complications and reduce surgical time.
Esen A, Soganci E, Dolanmaz E, et al. Evaluation of stress by finite element analysis of the midface and skull base at the time of midpalatal osteotomy in models with or without pterygomaxillary dysjunction. Br J Oral Maxillofac Surg 2018;56(3):177–181. DOI: 10.1016/j.bjoms.2018.01.001.
Pereira MD, Koga AF, Prado GPR, et al. Complications from surgically assisted rapid maxillary expansion with HAAS and Hyrax expanders. J Craniofac Surg 2018;29(2):275–278. DOI: 10.1097/SCS.0000000000004079.
Hamedi Sangsari A, Sadr-Eshkevari P, Al-Dam A, et al. Surgically assisted rapid palatomaxillary expansion with or without pterygomaxillary disjunction: a systematic review and meta-analysis. J Oral Maxillofac Surg 2016;74(2):338–348. DOI: 10.1016/j.joms.2015.06.161.
Sygouros A, Motro M, Ugurlu F, et al. Surgically assisted rapid maxillary expansion. An evaluation of different surgical techniques and their effect on maxillary dentoskeletal complex based on cone-beam computed tomography. Preliminary report. Orthod Fr 2014;85(2):175–187. DOI: 10.1051/orthodfr/2014005.
Liberati A, Altman DG, Tetzlaff J, et al. The prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009;62:1–34. DOI: 10.1016/j.jclinepi.2009. 06.006.
Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011], In: Higgins JPT, Green S The Cochrane Collaboration; 2011. Available at: https://handbook-5-1.cochrane.org/. Accessed June 26, 2019.
DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials 2015;45(Pt A):139–145.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21(11):1539–1558. DOI: 10.1002/sim.1186.
Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315(7109):629–634. DOI: 10.1136/bmj.315.7109.629.
Ferraro-Bezerra M, Tavares RN, de Medeiros JR, et al. Effects of pterygomaxillary separation on skeletal and dental changes after surgically assisted rapid maxillary expansion: a single-center, double-blind, randomized clinical trial. J Oral Maxillofac Surg 2018;76(4): 844–853. DOI: 10.1016/j.joms.2017.08.032.
Laudemann K, Santo G, Revilla C, et al. Assessment of surgically assisted rapid maxillary expansion regarding pterygomaxillary disjunction using thin volume-rendering technique: in variance analysis and in reliability, accuracy, and validity. J Oral Maxillofac Surg 2011;69(10):2631–2643. DOI: 10.1016/j.joms.2010.12.007.
Zandi M, Miresmaeili A, Heidari A, et al. The necessity of pterygomaxillary disjunction in surgically assisted rapid maxillary expansion: a short-term, double-blind, historical controlled clinical trial. J Craniomaxillofac Surg 2016;44(9):1181–1186. DOI: 10.1016/j.jcms.2016.04.026.
Laudemann K, Petruchin O, Mack MG, et al. Evaluation of surgically assisted rapid maxillary expansion with or without pterygomaxillary disjunction based upon preoperative and post-expansion 3D computed tomography data. Oral Maxillofac Surg 2009;13(3):159–169. DOI: 10.1007/s10006-009-0167-3.
Pereira MD, de Abreu RA, Prado GP, et al. Strategies for surgically assisted rapid maxillary expansion according to the region of transverse maxillary deficiency. Int J Oral Maxillofac Surg 2012;41(9):1127–1130. DOI: 10.1016/j.ijom.2012.03.028.
Blæhr TL, Mommaerts MY, Kjellerup AD, et al. Surgically assisted rapid maxillary expansion with bone-borne vs tooth-borne distraction appliances-a systematic review. Int J Oral Maxillofac Surg 2019;48(4):492–501. DOI: 10.1016/j.ijom.2018.12.010.
Rômulo de Medeiros J, Ferraro Bezerra M, Gurgel Costa FW, et al. Does pterygomaxillary disjunction in surgically assisted rapid maxillary expansion influence upper airway volume? A prospective study using dolphin imaging 3D. Int J Oral Maxillofac Surg 2017;46(9):1094–1101. DOI: 10.1016/j.ijom.2017.04.010.
Vasconcelos BCE, Caubi AF, Dias E, et al. Surgically assisted rapid maxillary expasion: a preliminar study. Braz J Otorhinolaryngol 2006;72(4):457–461. DOI: 10.1016/S1808-8694(15)30990-3.