Le Fort I osteotomy in cleft patients: Maxillary advancement and velopharyngeal function

Abstract

Background: Maxillary advancement may affect speech in cleft patients. Aims: To evaluate whether the amount of maxillary advancement in Le Fort I osteotomy affects velopharyngeal function (VPF) in cleft patients. Methods: Ninety-three non-syndromic cleft patients (51 females, 42 males) were evaluated retrospectively. All patients had undergone a Le Fort I or bimaxillary (n=24) osteotomy at Helsinki Cleft Palate and Craniofacial Center. Preoperative and postoperative lateral cephalometric radiographs were digitized to measure the amount of maxillary advancement. Pre-and postoperative speech was assessed perceptually and instrumentally by experienced speech therapists. Student´s ttest and Mann-Whitney's U-test were used in the statistical analyses. Kappa statistics were calculated to assess reliability. Results: The mean advancement of A point was 4.0 mm horizontally (range:-2.8-11.3) and 3.9 mm vertically (range-14.2-3.9). Although there was a negative change in VPF, the amount of maxillary horizontal or vertical movement did not significantly influence the VPF. There was no difference between the patients with maxillary and bimaxillary osteotomy. Conclusions: The amount of maxillary advancement does not affect the velopharyngeal function in cleft patients.

Precision Pharyngeal Flap: An Individualized, Patient-Specific Surgery for the Treatment of Velopharyngeal Insufficiency

“…Sometimes, maxillary advancement is considered to give negative changes to the velopharyngeal function and speech. 6,7 Posterior pharyngeal flap surgery, introduced by Passavant 8 and Schoenborn, 9 was popularized by Rosenthal in 1924. 10 While Rosenthal advocated inferiorly based pharyngeal flap, Sanvenero-Rosselli described a superiorly based pharyngeal flap.…”

Le Fort I Osteotomy in Cleft Patients: Maxillary Advancement and Articulation

“…Maxillary advancement can have a significant negative impact on velopharyngeal insufficiency (VPI). 9,15,19,20 Velopharyngeal insufficiency might have an influence on speech by mechanism of compensatory articulation and weakness of pressure consonants. In our previous study, with one hundred cleft patients who had undergone maxillary advancement, VPI deteriorated on 33 patients.…”

“…It is well documented that maxillary advancement may have a positive effect on articulation in patients with clefts, 8–12 whereas velopharyngeal function can be adversely affected 8–10,13,14,15,16–20 . The articulation may improve as the malocclusion and the relationship between the lips and upper and lower teeth are normalized.…”

Oral Rehabilitation of Bilateral Cleft Lip and Palate Patient with Simultaneous LeFort I Osteotomy and Zygomatic Implants: A Case Report

“…Cleft lip and palate (CLP) are common congenital malformations of the head and neck with genetic and environmental risk factors (Worley et al, 2018). Orofacial clefts can significantly affect the quality of life of the patients in terms of speech, mastication and aesthetics (Crockett and Goudy, 2014; Harjunpää et al, 2019). In literature there are various protocols available for repair of CLP and choice of surgical method of repair depends on cleft extent, surgeon preference and comorbid conditions of the patients (Dao and Goudy, 2016; Worley et al, 2018).…”

“…CLPs are frequently associated with a 3-dimensionally deficient maxilla in their midfacial anatomy and various degrees of maxillary hypoplasia (Roy et al, 2019; Velasques et al, 2020). Since 1970, maxillary advancement with Le Fort I osteotomy is the most common procedure in CLP patients with a significant relapse in the postoperative period (Obwegeser, 1962; Wong et al, 2016; Yamaguchi et al, 2016; Harjunpää et al, 2019; Susarla et al, 2020; Velasques et al, 2020). Type of cleft, isolated maxillary advancement or bimaxillary surgery, presence of previous surgery, and use of bone graft in the osteotomy gap are the factors that can affect the relapse and stability in CLP patients (Hoffman and Brennan, 2004; Costa et al, 2006; Velasques et al, 2020).…”