{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:05:26Z","timestamp":1780067126073,"version":"3.54.0"},"reference-count":78,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the impact of maxillary advancement by distraction osteogenesis (DO) on the pharyngeal airway including the following parameters in patients with cleft lip and palate (CLP), with a secondary focus on long-term changes \u22651 year: palatal pharyngeal space, superior posterior pharyngeal space, middle pharyngeal space, inferior pharyngeal space, epiglottic pharyngeal space, velar angle, velar length, and need ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A comprehensive search was conducted in Medline through PubMed, Scopus, Cochrane databases, Embase, and Directory of Open Access Journals through October 2024. Studies were assessed for pharyngeal airway changes at three time points: pre-DO (T1), post-DO (T2), and \u22651-year post-DO (T3). Quality was assessed using the National Institute of Health tool for before\u2013after (pre\u2013post) studies with no control group. Meta-analysis was conducted using Cochrane Review Manager (RevMan) Version 5.3. A random effect model assessed the mean difference (MD) in parameters representing the pharyngeal airway at T1, T2, and T3. GRADE criterion assessed the certainty of evidence. The protocol is officially registered with PROSPERO (CRD42023444533). In this systematic review, we followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The meta-analysis included 10 studies with 135 patients. The included studies ranged from fair to good quality. Significant increases were observed in pharyngeal space post-DO, particularly in superior and middle pharyngeal regions. Slight relapse was noted after 1 year, but overall, airway improvement remained significant. Evidence certainty by GRADE assessment revealed high to moderate evidence except for need ratio (low).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Maxillary advancement by DO significantly improves pharyngeal airway in CLP patients, with minimal relapse after 1 year.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/042425-320.1","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:51:50Z","timestamp":1770771110000},"page":"353-365","source":"Crossref","is-referenced-by-count":0,"title":["Pharyngeal airway changes following maxillary advancement by distraction osteogenesis among patients with cleft lip and palate: a systematic review and meta-analysis"],"prefix":"10.2319","volume":"96","author":[{"given":"Prateek","family":"Shakti","sequence":"first","affiliation":[{"name":"Assistant professor, Orthodontics and Dentofacial Orthopedics, Department of Dental Surgery, All India Institute of Medical Sciences\u2014Central Armed Police Forces Institute of Medical Sciences, New Delhi, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhinav","family":"Singh","sequence":"additional","affiliation":[{"name":"Professor, Department of Dentistry, Regional Training Centre for Oral Health Promotion, All India Institute of Medical Sciences, Bhopal, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Purohit","sequence":"additional","affiliation":[{"name":"Senior Research Officer, Resource Centre for Health Technology Assessment, All India Institute of Medical Sciences, Bhopal, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saumya","family":"Taneja","sequence":"additional","affiliation":[{"name":"Reader, Department of Pediatric and Preventive Dentistry Inderprastha Dental College and Hospital, Ghaziabad, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jitendra","family":"Kumar","sequence":"additional","affiliation":[{"name":"Associate Professor, Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Ahmedabad, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreevatsan","family":"Raghavan","sequence":"additional","affiliation":[{"name":"Project Manager, Heat in Pregnancy India Project, Centre for Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, India."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i1945-7103-96-3-353-b01","series-title":"Angle Orthod","first-page":"962","article-title":"Velopharyngeal changes after maxillary distraction in cleft patients using a rigid external distraction device: a retrospective study","volume":"86","author":"Taha","year":"2016","unstructured":"Taha M,\nElsheikh YM. 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J Oral Maxillofac Surg. 2012;70:e133\u2013e140."},{"key":"i1945-7103-96-3-353-b03","series-title":"J Pers Med","first-page":"543","article-title":"Assessing the impact of transcutaneous maxillary distraction osteogenesis on pharyngeal airway volume in children with cleft lip and palate: a 3D evaluation study","volume":"13","author":"Chan","year":"2023","unstructured":"Chan CH,\nTsai CY,\nLai JP,\nLin SS,\nChang YJ. Assessing the impact of transcutaneous maxillary distraction osteogenesis on pharyngeal airway volume in children with cleft lip and palate: a 3D evaluation study. J Pers Med. 2023;13:543."},{"key":"i1945-7103-96-3-353-b04","series-title":"Contemp Clin Dent","first-page":"236","article-title":"Profile changes and stability following distraction osteogenesis with rigid external distraction in adult cleft lip and palate deformities","volume":"8","author":"Painatt","year":"2017","unstructured":"Painatt JM,\nVeeraraghavan R,\nPuthalath U,\nPeter S,\nRao LP,\nKuriakose M. Profile changes and stability following distraction osteogenesis with rigid external distraction in adult cleft lip and palate deformities. Contemp Clin Dent. 2017;8:236\u2013243."},{"key":"i1945-7103-96-3-353-b05","series-title":"Cleft Palate Craniofac J","first-page":"255","article-title":"Cephalometric evaluation of airways after maxillary anterior advancement by distraction osteogenesis in cleft lip and palate patients: a systematic review","volume":"49","author":"Sharshar","year":"2012","unstructured":"Sharshar HH,\nEl-Bialy TH. Cephalometric evaluation of airways after maxillary anterior advancement by distraction osteogenesis in cleft lip and palate patients: a systematic review. 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Orthod Craniofac Res. 2004;7:189\u2013197."},{"key":"i1945-7103-96-3-353-b10","series-title":"Sci Rep","first-page":"12260","article-title":"Airway changes after cleft orthognathic surgery evaluated by three-dimensional computed tomography and overnight polysomnographic study","volume":"7","author":"Chang","year":"2017","unstructured":"Chang CS,\nWallace CG,\nHsiao YC, et al. Airway changes after cleft orthognathic surgery evaluated by three-dimensional computed tomography and overnight polysomnographic study. Sci Rep. 2017;7:12260."},{"key":"i1945-7103-96-3-353-b11","series-title":"J Ind Orthod Soc","first-page":"219","article-title":"Immediate and long-term changes in the pharyngeal airway passage following maxillary advancement with distraction osteogenesis in adult patients with cleft lip and palate","volume":"45","author":"Jena","year":"2011","unstructured":"Jena AK,\nRattan V,\nSingh SP,\nUtreja A. Immediate and long-term changes in the pharyngeal airway passage following maxillary advancement with distraction osteogenesis in adult patients with cleft lip and palate. J Ind Orthod Soc 2011;45:219\u2013223."},{"key":"i1945-7103-96-3-353-b12","series-title":"Cleft Palate Craniofac J","first-page":"477","article-title":"The effect of cranio-maxillofacial osteotomies and distraction osteogenesis on speech and velopharyngeal status: a critical review","volume":"43","author":"Chanchareonsook","year":"2006","unstructured":"Chanchareonsook N,\nSamman N,\nWhitehill TL. The effect of cranio-maxillofacial osteotomies and distraction osteogenesis on speech and velopharyngeal status: a critical review. 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Open J Stomatol. 2016;6;22\u201327."},{"key":"i1945-7103-96-3-353-b19","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"538","article-title":"Effect of maxillary distraction osteogenesis on velopharyngeal function: a pilot study","volume":"93","author":"Harada","year":"2002","unstructured":"Harada K,\nIshii Y,\nIshii M,\nImaizumi H,\nMibu M,\nOmura K. Effect of maxillary distraction osteogenesis on velopharyngeal function: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93:538\u2013543."},{"key":"i1945-7103-96-3-353-b20","series-title":"China J Oral Maxillofac Surg","first-page":"427","article-title":"Comparative study of modified tooth-borne anterior maxillary segmental distraction osteogenesis and Le Fort I osteotomy on velopharyngeal structure changes in cleft lip palate patients","volume":"18","author":"Mou","year":"2020","unstructured":"Mou S,\nZhu Y,\nDu C, et al. Comparative study of modified tooth-borne anterior maxillary segmental distraction osteogenesis and Le Fort I osteotomy on velopharyngeal structure changes in cleft lip palate patients. China J Oral Maxillofac Surg. 2020;18:427\u2013433."},{"key":"i1945-7103-96-3-353-b21","series-title":"J Craniofac Surg","first-page":"312","article-title":"Velopharyngeal changes after maxillary advancement in cleft patients with distraction osteogenesis using a rigid external distraction device: a 1-year cephalometric follow-up","volume":"10","author":"Ko","year":"1999","unstructured":"Ko EW,\nFigueroa AA,\nGuyette TW,\nPolley JW,\nLaw WR. Velopharyngeal changes after maxillary advancement in cleft patients with distraction osteogenesis using a rigid external distraction device: a 1-year cephalometric follow-up. 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Evaluation of velopharyngeal changes and mechanisms in upper airway following maxillary advancement by LeFort I osteotomy in patients with cleft: a retrospective study. J Cleft Lip Palate Craniofac Anomal. 2018;5:97\u2013105."},{"key":"i1945-7103-96-3-353-b24","series-title":"J Craniofac Surg","first-page":"1209","article-title":"Comparison of treatment outcome and stability between distraction osteogenesis and LeFort I osteotomy in cleft patients with maxillary hypoplasia","volume":"18","author":"Baek","year":"2007","unstructured":"Baek SH,\nLee JK,\nLee JH,\nKim MJ,\nKim JR. Comparison of treatment outcome and stability between distraction osteogenesis and LeFort I osteotomy in cleft patients with maxillary hypoplasia. 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Cleft Palate Craniofac J. 2007;44:274\u2013277."},{"key":"i1945-7103-96-3-353-b27","series-title":"Cleft Palate Craniofac J","first-page":"137","article-title":"Maxillary distraction osteogenesis in cleft lip and palate patients with skeletal anchorage","volume":"44","author":"Minami","year":"2007","unstructured":"Minami K,\nMori Y,\nTae-Geon K,\nShimizu H,\nOhtani M,\nYura Y. Maxillary distraction osteogenesis in cleft lip and palate patients with skeletal anchorage. Cleft Palate Craniofac J. 2007;44:137\u2013141."},{"key":"i1945-7103-96-3-353-b28","series-title":"Int J Oral Maxillofac Surg","first-page":"493","article-title":"Maxillary distraction osteogenesis using Le Fort I osteotomy without intraoperative down-fracture","volume":"35","author":"Yamauchi","year":"2006","unstructured":"Yamauchi K,\nMitsugi M,\nTakahashi T. Maxillary distraction osteogenesis using Le Fort I osteotomy without intraoperative down-fracture. Int J Oral Maxillofac Surg. 2006;35:493\u2013498."},{"key":"i1945-7103-96-3-353-b29","series-title":"Int J Oral Maxillofac Surg","first-page":"473","article-title":"Long-term results in maxillary deficiency using intraoral devices","volume":"34","author":"Rachmiel","year":"2005","unstructured":"Rachmiel A,\nAizenbud D,\nPeled M. Long-term results in maxillary deficiency using intraoral devices. Int J Oral Maxillofac Surg. 2005;34:473\u2013479."},{"key":"i1945-7103-96-3-353-b30","series-title":"Int J Oral Maxillofac Surg","first-page":"122","article-title":"Velar ascent and morphological factors affecting velopharyngeal function in patients with cleft palate and noncleft controls: a cephalometric study","volume":"34","author":"Satoh","year":"2005","unstructured":"Satoh K,\nWada T,\nTachimura T,\nFukuda J. Velar ascent and morphological factors affecting velopharyngeal function in patients with cleft palate and noncleft controls: a cephalometric study. Int J Oral Maxillofac Surg. 2005;34:122\u2013126."},{"key":"i1945-7103-96-3-353-b31","series-title":"Cleft Palate Craniofac J","first-page":"355","article-title":"Morphological evaluation of changes in velopharyngeal function following maxillary distraction in patients with repaired cleft palate during mixed dentition","volume":"41","author":"Satoh","year":"2004","unstructured":"Satoh K,\nNagata J,\nShomura K, et al. Morphological evaluation of changes in velopharyngeal function following maxillary distraction in patients with repaired cleft palate during mixed dentition. Cleft Palate Craniofac J. 2004;41:355\u2013363."},{"key":"i1945-7103-96-3-353-b32","series-title":"Plast Reconstr Surg","first-page":"818","article-title":"Orthopedic intrusion of premaxilla with distraction devices before alveolar bone grafting in patients with bilateral cleft lip and palate","volume":"113","author":"Liou","year":"2004","unstructured":"Liou EJ,\nChen PK,\nHuang CS,\nChen YR. Orthopedic intrusion of premaxilla with distraction devices before alveolar bone grafting in patients with bilateral cleft lip and palate. Plast Reconstr Surg. 2004;113:818\u2013826."},{"key":"i1945-7103-96-3-353-b33","series-title":"J Oral Maxillofac Surg","first-page":"959","article-title":"Soft tissue profile changes after maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: a 1-year follow-up","volume":"58","author":"Ko","year":"2000","unstructured":"Ko EW,\nFigueroa AA,\nPolley JW. Soft tissue profile changes after maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: a 1-year follow-up. J Oral Maxillofac Surg. 2000;58:959\u2013969."},{"key":"i1945-7103-96-3-353-b34","series-title":"Cleft Palate J","first-page":"134","article-title":"Nasal pathway resistance in normal and cleft and lip and palate subjects","volume":"6","author":"Warren","year":"1969","unstructured":"Warren DW,\nDuany LF,\nFischer ND. Nasal pathway resistance in normal and cleft and lip and palate subjects. Cleft Palate J. 1969;6:134\u2013140."},{"key":"i1945-7103-96-3-353-b35","series-title":"J Maxillofac Surg","first-page":"40","article-title":"Logopedic findings following advancement of the maxilla","volume":"4","author":"Schwartz","year":"1976","unstructured":"Schwartz C,\nGrunner E. Logopedic findings following advancement of the maxilla. 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J Cranio-Maxillofac Surg. 1994;22:182\u2013188."},{"key":"i1945-7103-96-3-353-b38","series-title":"J Maxillofac Surg","first-page":"685","article-title":"Alterations in velopharyngeal function after maxillary advancement","volume":"48","author":"Watzke","year":"1990","unstructured":"Watzke I,\nTurvey TA,\nWarren DW,\nDalston R. Alterations in velopharyngeal function after maxillary advancement. J Maxillofac Surg. 1990;48:685\u2013689."},{"key":"i1945-7103-96-3-353-b39","series-title":"Int J Pediatr Otorhinolaryngol","first-page":"171","article-title":"Changes in velopharyngeal valving with age","volume":"11","author":"Siegel-Sadewitz","year":"1986","unstructured":"Siegel-Sadewitz VL,\nShprintzen RJ. Changes in velopharyngeal valving with age. Int J Pediatr Otorhinolaryngol. 1986;11:171\u2013182."},{"key":"i1945-7103-96-3-353-b01","series-title":"Angle Orthod","first-page":"962","article-title":"Velopharyngeal changes after maxillary distraction in cleft patients using a rigid external distraction device: a retrospective study","volume":"86","author":"Taha","year":"2016","unstructured":"Taha M,\nElsheikh YM. Velopharyngeal changes after maxillary distraction in cleft patients using a rigid external distraction device: a retrospective study. Angle Orthod. 2016;86:962\u2013968."},{"key":"i1945-7103-96-3-353-b02","series-title":"J Oral Maxillofac Surg","first-page":"e133","article-title":"Pharyngeal airway changes associated with maxillary distraction osteogenesis in adult cleft lip and palate patients","volume":"70","author":"Aksu","year":"2012","unstructured":"Aksu M,\nTaner T,\nSahin-Veske P,\nKocadereli I,\nKonas E,\nMavili ME. Pharyngeal airway changes associated with maxillary distraction osteogenesis in adult cleft lip and palate patients. J Oral Maxillofac Surg. 2012;70:e133\u2013e140."},{"key":"i1945-7103-96-3-353-b03","series-title":"J Pers Med","first-page":"543","article-title":"Assessing the impact of transcutaneous maxillary distraction osteogenesis on pharyngeal airway volume in children with cleft lip and palate: a 3D evaluation study","volume":"13","author":"Chan","year":"2023","unstructured":"Chan CH,\nTsai CY,\nLai JP,\nLin SS,\nChang YJ. Assessing the impact of transcutaneous maxillary distraction osteogenesis on pharyngeal airway volume in children with cleft lip and palate: a 3D evaluation study. J Pers Med. 2023;13:543."},{"key":"i1945-7103-96-3-353-b04","series-title":"Contemp Clin Dent","first-page":"236","article-title":"Profile changes and stability following distraction osteogenesis with rigid external distraction in adult cleft lip and palate deformities","volume":"8","author":"Painatt","year":"2017","unstructured":"Painatt JM,\nVeeraraghavan R,\nPuthalath U,\nPeter S,\nRao LP,\nKuriakose M. Profile changes and stability following distraction osteogenesis with rigid external distraction in adult cleft lip and palate deformities. Contemp Clin Dent. 2017;8:236\u2013243."},{"key":"i1945-7103-96-3-353-b05","series-title":"Cleft Palate Craniofac J","first-page":"255","article-title":"Cephalometric evaluation of airways after maxillary anterior advancement by distraction osteogenesis in cleft lip and palate patients: a systematic review","volume":"49","author":"Sharshar","year":"2012","unstructured":"Sharshar HH,\nEl-Bialy TH. Cephalometric evaluation of airways after maxillary anterior advancement by distraction osteogenesis in cleft lip and palate patients: a systematic review. Cleft Palate Craniofac J. 2012;49:255\u2013261."},{"key":"i1945-7103-96-3-353-b06","series-title":"Plast Reconstr Surg","first-page":"506","article-title":"Mandibular lengthening by gradual distraction: preliminary report","volume":"51","author":"Snyder","year":"1973","unstructured":"Snyder CC,\nLevine GA,\nSwanson HM,\nBrowne EZ Jr. Mandibular lengthening by gradual distraction: preliminary report. Plast Reconstr Surg. 1973;51:506\u2013508."},{"key":"i1945-7103-96-3-353-b07","series-title":"Plast Reconstr Surg","first-page":"1","article-title":"Lengthening the human mandible by gradual distraction","volume":"89","author":"McCarthy","year":"1992","unstructured":"McCarthy JG,\nSchreiber J,\nKarp N,\nThorne CH,\nGrayson BH. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg. 1992;89:1\u20138."},{"key":"i1945-7103-96-3-353-b08","series-title":"Contemporary Treatment of Dentofacial Deformity","first-page":"357","article-title":"Maxillofacial distraction osteogenesis","author":"Crago","year":"2003","unstructured":"Crago CA,\nProffit WR,\nRuiz RL. Maxillofacial distraction osteogenesis. In: \nProffit WR,\nWhite RPJr,\nSarver DM, eds. Contemporary Treatment of Dentofacial Deformity. St. Louis, MO: Mosby; 2003:357\u2013393."},{"key":"i1945-7103-96-3-353-b09","series-title":"Orthod Craniofac Res","first-page":"189","article-title":"Effects of maxillary distraction osteogenesis on the upper-airway size and nasal resistance in subjects with cleft lip and palate","volume":"7","author":"Mochida","year":"2004","unstructured":"Mochida M,\nOno T,\nSaito K,\nTsuiki S,\nOhyama K. Effects of maxillary distraction osteogenesis on the upper-airway size and nasal resistance in subjects with cleft lip and palate. 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Orthopedic intrusion of premaxilla with distraction devices before alveolar bone grafting in patients with bilateral cleft lip and palate. Plast Reconstr Surg. 2004;113:818\u2013826."},{"key":"i1945-7103-96-3-353-b33","series-title":"J Oral Maxillofac Surg","first-page":"959","article-title":"Soft tissue profile changes after maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: a 1-year follow-up","volume":"58","author":"Ko","year":"2000","unstructured":"Ko EW,\nFigueroa AA,\nPolley JW. Soft tissue profile changes after maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: a 1-year follow-up. 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