Influence of Orthognathic Surgery on Velopharyngeal Function in Patients with Cleft Palate

Abstract

Introduction: In orthognathic surgery for cleft palate patients with maxillary undergrowth, it should be carefully planned because maxillary advancement affects velopharyngeal function (VPF). The purpose of this study was to evaluate whether the amount of maxillary advancement in Le Fort I osteotomy affects VPF in cleft palate patients.

Subjects and methods: Six patients with cleft palate who underwent orthognathic surgery between 2019 and 2022 were included in this study. VPF was evaluated using a 4-grade based on the cleft palate language test and a nasalance score before and after surgery. The relationship between maxillary advancement and VPF was investigated.

Results: In cases 1 to 4, surgeries were undergone with ideal amounts of maxillary advancement and VPF was not affected after surgeries. In case 5, mild insufficiency grade of VPF suggested that maxillary advancement might affect VPF, but 3 mm of maxillary advancement was planned and performed considering the patient’s chief complaint of improvement of facial appearance. As a result, mild exacerbation of VPF was observed after surgery. In case 6, the preoperative VPF insufficiency was mild, but the articulation disorder was observed. The maxilla was not surgically moved anteriorly, only with canting correction, to preserve speech function. As the result, there was no postoperative deterioration of VPF.

Discussion: In orthognathic surgery for patients with cleft palate, it is necessary to consider the amount of maxillary advancement and formulate a treatment plan from viewpoints of occlusion, VPF, and facial appearance in addition to the patient’s chief complaint.