Videofluoroscopic Findings as Predictors of Velopharyngeal Insufficiency After Orthognathic Surgery in Patients With Cleft Lip and Palate

Abstract

Background Midface retrusion is a common problem in patients with cleft lip and palate owing to the lack of adequate growth of the maxilla. Midface advancement surgery is a definite treatment for midface retrusion; however, the subsequent oropharyngeal airway changes might result in velopharyngeal insufficiency (VPI) in affected patients. Determining the predictors of VPI beforehand and modifying the surgical procedure would be beneficial. Materials and Methods A retrospective review of 42 patients with cleft lip and palate who underwent orthognathic surgery from 2013 to 2014 was performed. A total of 25 patients met the inclusion criteria and had undergone complete pre- and postsurgery videofluoroscopy, nasopharyngoscopy (NPS), and speech assessment. We compared 2 groups of patients, those who showed NPS finding changes of more than 0.1 (8 patients) and those without changes (17 patients), by measuring the distances of the contact point to the tip of the velum, gap size at maximum closure (MC) and rest, contact area length, lateral wall closure rate, closure velocity, and 2 angles (from the velum to the hard palate and genu) at MC and rest. The amount of maxillary advancement was also recorded. Results Among the 8 patients with NPS finding changes, 3 underwent Furlow palatoplasty for VPI. No significant difference was found in the amount of maxillary advancement between the groups (5.8 vs 5.7 mm). Significant differences were found in the preoperative gap size at MC and angle at the genu at MC (P = 0.035 and .012). These could be considered as the predictors before surgery. After surgery, a significant difference was found in the contact area, lateral wall closure rate, and gap size at MC (P = 0.005, 0.018, and 0.01). Conclusion Videofluoroscopy is a relatively applicable method of determining dynamic changes in the velum function. By performing videofluoroscopy before midface advancement surgery in patients with cleft lip and palate, we may predict the risk of VPI and consider alternative surgical strategies.

Subjective and Objective Evaluation of Speech in Adult Patients With Repaired Cleft Palate

“…In other cases, postoperative speech disorders is due to velopharyngeal insufficiency (VPI) after cleft palate repair,these patients could not form a good resonant cavity structure and appeared obvious hypernasality and nasal air leakage. [2][3][4] Patients with VPI may have abnormal palatal morphology, such as the soft palate being too short, the hard and soft palate being cleft again, the soft palate muscle being thin, the pharyngeal cavity being large and deep, or palatal perforation and other structural defects leading to VPI. 5,6 Human speech is produced by air flowing from the lungs through the vocal tract.…”

“…Some patients after palatopharynx have complete velopharyngeal closure function (Velopharyngeal Competence, VPC) with good articulation organ conditions, but their speech disturbance caused by a wrong way of pronouncing. In other cases, postoperative speech disorders is due to velopharyngeal insufficiency (VPI) after cleft palate repair,these patients could not form a good resonant cavity structure and appeared obvious hypernasality and nasal air leakage 2–4 . Patients with VPI may have abnormal palatal morphology, such as the soft palate being too short, the hard and soft palate being cleft again, the soft palate muscle being thin, the pharyngeal cavity being large and deep, or palatal perforation and other structural defects leading to VPI 5,6 …”