Stability outcomes of internal and external distractors in maxillary distraction osteogenesis for cleft lip and palate: A systematic review
Why this work is in the frame
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Bibliographic record
Abstract
Cleft lip and palate (CLP) often result in maxillary hypoplasia due to surgical scarring and impaired growth. In such cases, distraction osteogenesis (DO) is a well-established technique for achieving maxillary advancement. Both internal and external distractors are widely applied, yet their relative long-term skeletal stability is not known. To systematically evaluate the long-term skeletal stability of Le Fort I osteotomy with distraction osteogenesis using internal and external distraction devices in managing maxillary deficiency among CLP patients. Following PRISMA guidelines and with prior PROSPERO registration (CRD420251026923), a comprehensive search of PubMed, Scopus, and Web of Science databases was conducted up to April 6, 2025. Studies involving CLP patients who underwent maxillary distraction osteogenesis with either internal or external devices were included. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale and ROBINS-I tools. Thirteen studies met the inclusion criteria. Internal distractors demonstrated favorable long-term skeletal stability, with reported relapse rates ranging from 0% to 15%. External distractors, most notably the rigid external distractor (RED), produced more advancement but had increased rates of early relapse (as high as 30%). Bone-borne RED systems had better results compared with tooth-borne systems. The majority of relapses happened during the first 6 months following distraction, most notably in the vertical plane. Le Fort I osteotomy was the most commonly employed surgical procedure. External distractors allowed greater advancement but were associated with relapse rates up to 30%, especially in the vertical plane. Internal distractors, while offering reduced vector control, provided superior long-term skeletal stability (relapse 0–15%) and improved patient comfort.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it