Pharyngeal airway changes following maxillary advancement by distraction osteogenesis among patients with cleft lip and palate: A systematic review and meta-analysis

Objectives: To evaluate the effect of maxillary advancement by distraction osteogenesis on pharyngeal airway dimensions in patients with cleft lip and palate and assess long-term airway changes. Methods: A comprehensive literature search was conducted across PubMed, Scopus, Cochrane, Embase, and DOAJ databases until October 2024. Eligible studies reporting airway changes at preoperative, immediate postoperative, and ≥1-year follow-up time points were included. Methodological quality was assessed using the National Institutes of Health tool for pre-post studies. Meta-analysis was performed using a random-effects model in RevMan 5.3. Certainty of evidence was graded using GRADE methodology following PRISMA guidelines. Results: Ten studies involving 135 patients were included. Significant increases were observed in superior and middle pharyngeal airway dimensions immediately after distraction osteogenesis. Although minor relapse was noted at one-year follow-up, overall airway improvement remained statistically significant. Evidence quality ranged from moderate to high for most airway parameters. Conclusions: Maxillary advancement by distraction osteogenesis significantly improves pharyngeal airway dimensions in cleft lip and palate patients, with sustained benefits and minimal long-term relapse.