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Page 6 of 15 Corthouts et al. Plast Aesthet Res 2020;7:46 I http://dx.doi.org/10.20517/2347-9264.2020.97

Figure 1. Flow chart showing the number of records identified and removed at each stage of the review. SNA: sella-nasion-A-point angle

Study characteristics
Most studies included in this review (73%) were published after 2010 [6,12-18] [Table 2]. Six studies were
conducted in Asia (55%) and 5 were conducted in Europe (45%). The variety of treatment protocols that
were administered in the different studies in the articles, as well as whether or not presurgical orthopedics
[18]
[12]
was performed, is shown in Table 2. Sample sizes consisted of 10 subjects to 128 subjects . Seven articles
included a healthy, noncleft control group in their study [10,11,13-17] . The authors used a variety of surgical
techniques. Regarding cheiloplasty, the following techniques were used: (modified) Millard rotation-
advancement technique [9-12,15,16] , triangular technique (by Tennison with modifications) [9,11,13,18] and modified
[12]
Delaire technique . Three articles did not specify the technique used for lip repair [6,14,17] . Concerning
closure of the palate several techniques are listed, which can be categorized as follows: (modified) von
[10]
Langenbeck [9,12,13] , pushback palatoplasty , cranial or caudally pedicled vomer flap [9,12-14,18] , intravelar
[12]
[6]
[11]
veloplasty , modified Pigott technique and two-flap palatoplasty [14-16] . Khanna et al. provided no
description of the technique used for palate repair.
Three different surgical techniques were described for alveolar cleft closure: gingivoperiosteoplasty [11,12] ,
[14]
primary bone grafting and secondary bone grafting [11,12,16,18] . Three studies declared that the patients in
the samples had not undergone bone grafting surgery [9,10,17] , whereas three studies had no information on
whether or not bone grafting surgery had been done [6,13,15] .

The mean age at the time of surgical repair in patients with repaired UCLP varied according to the surgical
[15]
[12]
[9]
[6]
protocol: lip repair before 15 weeks until 2 years ; soft palate closure from 4 months to 5 years ; hard
[9]
[12]
[14]
palate closure from 3 months to 4 years and alveolar cleft repair from 6 months to 11 years [12,16] .
In 3 studies, the surgical protocol consisted of the primary one-stage surgery of UCLP: simultaneous repair