The effect of maxillary advancement on velopharyngeal insufficiency in cleft patients

Midface hypoplasia is a common developmental problem in cleft palate patients, 30–40% of these patients requires surgery during adolescence. Generally with the maxillary advancement, the soft palate moves forward altering or worsening the speech. The purpose of this study is to evaluate how the maxillary advancement affects velopharyngeal function.

This is a prospective study of 8 patients who underwent orthognathic surgery. All of them had unilateral cleft lip and palate. A protocol was applied to each patient. The preoperative variables recorded were: age, number and type of pharyngeal surgeries, speech therapist evaluation with nasopharyngoscopy (VPI score) and cephalometric analysis of the maxillary position. During the surgery the number of plates used and the maxillary movements were recorded. Postoperative speech therapist evaluation with nasopharyngoscopy took place after the 1st and 3rd month. Follow up x-rays with cephalometric analysis were taken at months 1, 3, 6 and 12 after the surgery.

The average maxillary advancement was 6 mm. The velopharyngeal function changed in one patient from VPI score 3–7, this patient had not had any previous pharyngeal surgeries.

This study confirms that velopharyngeal function can be changed with maxillary advancement in patients with cleft lip and palate. This is more frequent in patients that have preoperative borderline function. The amount of advancement and the prior pharyngeal surgeries are predictors of VPI after orthognathic surgery.

Conflict of interest: None declared.

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Jan 27, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on The effect of maxillary advancement on velopharyngeal insufficiency in cleft patients
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