Velopharyngeal Configuration Changes following Le Fort I Osteotomy with Maxillary Advancement in Patients with Cleft Lip and Palate: A Cephalometric Study

Abstract

Correction of maxillary hypoplasia by Le Fort I osteotomy with maxillary advancement increases the velopharyngeal cavity depth, which may impair velopharyngeal competence. The compensatory effects of the velopharyngeal soft tissue and posterior pharyngeal wall may alleviate this impairment to a certain extent.

Predictors of Velopharyngeal Dysfunction in Individuals With Cleft Palate Following Surgical Maxillary Advancement: Clinical and Tomographic Assessments

“…Within this context, investigators have indicated, as risk factors, the changes in nasopharyngeal depth, palatal length, and ratio between these measurements comparing the pre- and postoperative periods. Therefore, it is assumed that these factors might indicate, early in the preoperative evaluation, the risk of alteration in resonance after surgery (Schendel et al, 1979; Heliövaara et al, 2002; Kudo et al, 2014; Wu et al, 2015).…”

“…The process known as “velar elasticity” refers to elongation of the palate during the elevation movement. In patients following MA, this elongation is considered a compensatory behavior to maintain the velopharyngeal closure even after anterior maxillary displacement (Kummer et al, 1989; Kummer, 2014; Wu et al, 2015). This may explain why some patients in this study, who presented regular or even poor mobility of the palate before surgery, exhibited normal resonance after MA.…”

“…Cases with marked maxillomandibular discrepancy require orthognathic surgery for repositioning of bone bases at completion of orthodontic treatment (Trindade et al, 2003; Freitas et al, 2012; Pereira, 2012; Wu et al, 2015). This surgical procedure is used in 10% to 50% of individuals with cleft lip and palate (Good et al, 2007; Daskalogiannakis and Mehta, 2009; Broome et al, 2010; Pereira, 2012; Smedberg et al, 2014; Wu et al, 2015) and, among the several surgical techniques, Le Fort I osteotomy for maxillary advancement (MA) is the most commonly used surgical approach in this population. This procedure may be performed by fracture of 1 to 4 segments and allows horizontal, vertical, and transverse movements (Scartezini et al, 2007).…”

Orthognathic Surgery in Cleft Lip and Palate Patients

“…It is a difficult process to estimate soft tissue changes after orthognathic surgery and prevent them. This is because the adaptation of the velopharyngeal region for compensation of other regions is variable, and it is dependent on the personal characteristics of each patient and the capacity of tissues that are present or transplanted to become functional [74].…”

Avanço cirúrgico de maxila e ressonância de fala: comparação entre os tipos de fissura

“…In case of moderate to severe MMDs, it is necessary to perform surgical treatment by repositioning of the bone bases, to enhance the orofacial functions (2,10,11) , which occurs in nearly 10 to 50% of the population with CLP (9,12) . The type of surgery most frequently performed for correction of MMDs is the Le Fort I maxillary osteotomy for maxillary advancement (MA), which may be combined to osteotomies of the mandible and chin (13,14) .…”