Percorrer por autor "Gil, Nuno Alexandre dos Santos"
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- Horizontal alveolar osteogenic distraction for reconstruction of the alveolar process in cleft patients: systematic reviewPublication . Gil, Nuno Alexandre dos Santos; Pereira, JorgeClefts of lip and palate are among the most common congenital anomalies. The alveolar process is frequently affected, secondary alveolar bone graft (ABG) being the gold standard treatment for its reconstruction. However, failures do occur, with the dimension and morphology of the alveolar cleft being an important factor. Alternative and/or complementary techniques to address the limitations of secondary ABG in cases of wide alveolar clefts (WAC) have been reported, horizontal alveolar distraction osteogenesis (HAOD) being the most used. This study aims to provide an overview of the technical variations of HAOD to reconstruct alveolar clefts and compare their outcomes in terms of oronasal fistulas closure, bone reconstruction quality, and complications rate, accordingly with the available evidence. Studies on human individuals with congenital cleft lip/palate having alveolar clefts treated with any type of HAOD were selected. The search strategy was developed using Medical Subject Headings (MeSH) and applied to the PubMed, Web of Science (core collection), Embase, and Scopus databases. Demographic, clinical baseline, intervention, and clinical outcomes information were extracted, and the risk of bias was assessed. The selection process, data extraction and risk of bias evaluation, were conducted by two independent researchers with divergences solved through discussion and, if necessary, by mediation of a third researcher. A total of 313 studies were identified, and 21 (9 case series and 12 clinical cases) were eligible for final analysis, involving 67 patients (mean cleft dimension of 12.5 mm; 53 unilateral, 14 bilateral clefts), 74 HAOD (66 bifocal; 8 trifocal), and 92 transport discs. Among the included studies, numerous technical variations were observed, although common points existed. These included 17 distractor models, six distraction protocols, seven flap types, and six osteotomy types. Of the studies that reported relevant information, 92% indicated a significant reduction of oronasal fistulas, with an average reduction in size of 82%. In at least 56 sites of osteogenic distraction, the quality of new bone was presumed to be good, although no specific data on volume was provided. The most common complication was issues related to the distraction vector. Although the studies included present important risk of bias, the available data suggest that HAOD can be an important tool in dealing with alveolar process reconstruction in WAC. It appears that the technique can reduce the dimension of oronasal fistulas and alveolar clefts. Most cases were treated with tooth-borne distractors, but the evidence collected points towards a better control of the distraction vector with hybrid fixation and TPB utilization.