Predictors of Velopharyngeal Insufficiency After Le Fort I Maxillary Advancement in Patients With Cleft Palate

McComb, Ryan W.; Marrinan, Eileen M.; Nuss, Roger C.; LaBrie, Richard A.; Mulliken, John B.; Padwa, Bonnie L.

doi:10.1016/j.joms.2011.02.142

Cited by 75 publications

(48 citation statements)

References 15 publications

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“…These five patients were also found to have borderline VPD preoperatively. The results of their study supported those of other studies that there is no relationship between maxillary advancement and the amount of postoperative velopharyngeal disorders [71], and when orthognathic surgery and total maxillary distraction are compared in terms of speech and VPD, there is no significant difference [71][72][73]. Additionally, the finding that there is no correlation between postoperative speech impediment and preoperative borderline VPD was added to the literature which reported similar findings [71][72][73].…”

Section: Speech Impedimentsupporting

confidence: 76%

Orthognathic Surgery in Cleft Lip and Palate Patients

Yılmaz¹,

Demirkaya²

2020

Current Treatment of Cleft Lip and Palate

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Cleft lip and palate patients often exhibit severe dentofacial deformities that necessitate orthognathic surgery. Orthognathic surgery in these patients generally includes not only maxillary advancement, but also sagittal, horizontal, and vertical movement of both jaws. Surgical planning and execution presents many difficulties, caused by the presence of extensive scar tissues from previous surgeries, tissue deficiencies, the difficulty of aligning multiple segments of bone and soft tissues. Other challenges in cleft patients are complications related to post-surgical airway, speech, velopharyngeal insufficiency, nerve damage, and infections. This review is focused on orthognathic surgery in cleft lip and palate patients, management, techniques, success, and complications.

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Section: Speech Impedimentsupporting

confidence: 76%

Orthognathic Surgery in Cleft Lip and Palate Patients

Yılmaz¹,

Demirkaya²

2020

Current Treatment of Cleft Lip and Palate

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“…Intuitively, it may seem obvious that greater magnitudes of MMA would lead to more complications and poorer skeletal stability than smaller advancements. However, data from published studies demonstrate, no decrease in skeletal stability is associated with the large advancements seen in OSA patients 35 and that velopharyngeal insufficiency is not associated with the amount of maxillary advancement in cleft lip and palate patients 36 . Additionally, it has been shown that the magnitude of mandibular advancement and age alone do not correlate with changes in neurosensory outcomes following bilateral sagittal split osteotomies.…”

Section: Discussionmentioning

confidence: 98%

Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Pásseri

Choi

Kaban

et al. 2016

Journal of Oral and Maxillofacial Surgery

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Purpose To compare morbidity and mortality rates in obstructive sleep apnea (OSA) versus dentofacial deformity (DFD) patients undergoing equivalent maxillofacial surgical procedures. Patients and Methods Patients with OSA who underwent maxillomandibular advancement with genial advancement (MMA), at Massachusetts General Hospital Department of Oral and Maxillofacial Surgery, from December 2002 to June 2011, were matched to patients with DFD undergoing similar maxillofacial procedures during the same time period. They were compared with regards to demographic variables, medical comorbidities, perioperative management, intraoperative, early and late postoperative complications and mortality. Results A study group of 28 patients with OSA and a control group of 26 patients with DFD were compared. The patients with OSA were older (41.9±12.5 vs. 21.7±8.6years), had a higher ASA classification (2.0±0.5 vs. 1.3±0.6) and BMI (29.6±4.7 vs. 23.0±3.1kg/m2). They also had a greater number of medical comorbidities (2.4±2.3 vs. 0.7±1.0). More OSA than DFD patients had complications (28, 100% vs.19, 73%, p=0.003) and the total number of complications in the OSA group was higher (108 vs. 33, p<0.001). In the OSA group, 13.9% and in the DFD group 3.0% of the complications were classified as major. The absolute risk of a complication for the OSA group was 3.9 vs . 1.3 for the DFD group. The relative risk of complications in OSA compared to DFD was 3.0. No difference in mortality was found. Conclusions OSA patients were older, had more comorbidities and ultimately had a greater number of early, late, minor and major complications than those in the DFD group. The incidence of mortality in both groups was zero. MMA appears to be a safe procedure with regards to mortality but OSA patients should be counseled preoperatively regarding the relative increased risk of complications.

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“…According to these authors, those individuals who presented inadequate or marginal velopharyngeal closure before OS, objectively evaluated by measuring the size of the velopharyngeal orifice using the pressure-flow technique, were the ones who presented a deterioration of velopharyngeal function after OS. This is probably due to the extension of the soft palate before surgery and the increase in pharyngeal depth after OS, considered the most important risk factors for VPI after OS, when compared to the quantity of maxillary advancement, as demonstrated through cephalometric tracings and nasopharyngoscopy 30 . These authors suggested that patients who have a short palate in extension are at a disadvantage in relation to those with an adequate extension.…”

Section: Resultsmentioning

confidence: 99%

Ressonância da fala após tratamento cirúrgico da insuficiência velofaríngea secundária à cirurgia ortognática

et al. 2015

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OBJETIVO:investigar o efeito da cirurgia corretiva da insuficiência velofaríngea sobre a ressonância da fala de indivíduos nascidos com fissura palatina que passaram a apresentar hipernasalidade, após a cirurgia ortognática.MÉTODOS:foram analisados os resultados da ressonância de 23 pacientes com fissura labiopalatina corrigida cirurgicamente que apresentavam ressonância oronasal equilibrada antes da cirurgia ortognática e foram submetidos à correção cirúrgica da insuficiência velofaríngea, devido ao aparecimento de hipernasalidade após a cirurgia ortognática. Os pacientes foram submetidos à avaliação perceptivo-auditiva da fala para classificação da hipernasalidade, em três situações: 3 dias antes e 5 meses, em média, após a cirurgia ortognática e, 13 meses, em média, após a cirurgia corretiva da insuficiência velofaríngea. A hipernasalidade foi classificada utilizando-se escala de 4 pontos: 1=ausência de hipernasalidade; 2=hipernasalidade leve; 3=moderada e 4=grave. Os escores de hipernasalidade nas três situações estudadas foram comparados por meio do teste de Friedman, com nível de significância de 5% e, posteriormente, pelo teste de Tukey para comparações múltiplas.RESULTADOS:do total de 23 pacientes, houve eliminação do sintoma de fala após a correção da insuficiência velofaríngea em 83% (19/23), sendo os escores médios de nasalidade antes da cirurgia ortognática=1, após a cirurgia ortognática=3 e após a correção da insuficiência velofaríngea=1. Houve diferença estatisticamente significante entre as três situações estudadas (p<0,001).CONCLUSÃO:a cirurgia corretiva da insuficiência velofaríngea foi um tratamento efetivo na grande maioria dos casos que apresentaram hipernasalidade secundária à cirurgia ortognática, com retorno à condição de normalidade.

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Predictors of Velopharyngeal Insufficiency After Le Fort I Maxillary Advancement in Patients With Cleft Palate

Cited by 75 publications

References 15 publications

Orthognathic Surgery in Cleft Lip and Palate Patients

Orthognathic Surgery in Cleft Lip and Palate Patients

Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Ressonância da fala após tratamento cirúrgico da insuficiência velofaríngea secundária à cirurgia ortognática

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