Influence of primary palatal surgery on craniofacial morphology in patients with cleft palate only (CPO)—systematic review with meta-analysis

Abstract: Background: Cleft palate only (CPO) is the second most prevalent cleft type. Both the cleft and palatal scarring may affect craniofacial growth. The aim of this systematic review was to sum- marize scientific evidence on effect of palatal surgery on craniofacial morphology in CPO. Methods: A search was conducted in PubMed, PMC, WoS, Scopus, Embase, using the keywords: “cleft palate” AND (“craniofacial morphology” OR “cephalometric analysis”) NOT “lip” with inclusion and ex- clusion criteria ensuring confident, direct comparison between study groups. The quality assess- ment was performed with Arrive’s scale for radiologic examinations. Results: Of 713 potential arti- cles, 19 were subjected to qualitative analysis and 17 to meta-analysis, which confirmed reduced SNA in unoperated CPO versus non-cleft individuals. No scientific evidence was found directly assessing the effect of surgery on craniofacial morphology. The negative effect of palatal surgery was seen indirectly: in treated CPO versus non-cleft, the size effect of SNA is bigger than in un- treated CPO versus non-cleft. A high heterogeneity came from a few non-European publications. Conclusions: CPO is associated with sagittal maxillary deficiency resulting both from the cleft and from primary surgery, disregarding cleft severity in operated CPO patients. Ethnic differences in- fluence craniofacial morphology in CPO. This research received no external funding. Study protocol number in PROSPERO database: CRD42021268957.