Effect of maxillary advancement on velopharyngeal function in cleft lip and palate: 20 years of experience

Sérgio Éberson da Silva Maia; Déborah Rocha Seixas; Ana Paula Fukushiro; Inge Elly Kiemle Trindade; Andressa Sharllene Carneiro da Silva; Bruna Mara Adorno Marmontel Araújo; Renata Paciello Yamashita

doi:10.1016/j.jcms.2024.10.004

Effect of maxillary advancement on velopharyngeal function in cleft lip and palate: 20 years of experience

J Craniomaxillofac Surg. 2024 Oct 15:S1010-5182(24)00285-3. doi: 10.1016/j.jcms.2024.10.004. Online ahead of print.

Authors

Sérgio Éberson da Silva Maia¹, Déborah Rocha Seixas¹, Ana Paula Fukushiro², Inge Elly Kiemle Trindade³, Andressa Sharllene Carneiro da Silva⁴, Bruna Mara Adorno Marmontel Araújo⁴, Renata Paciello Yamashita⁵

Affiliations

¹ Postgraduate Program in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Sao Paulo, Brazil.
² Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Sao Paulo, Brazil; Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, University of Sao Paulo, Bauru, Sao Paulo, Brazil.
³ Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Sao Paulo, Brazil; Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo, Bauru, Sao Paulo, Brazil.
⁴ Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Sao Paulo, Brazil.
⁵ Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Sao Paulo, Brazil. Electronic address: rezeyama@usp.br.

PMID: 39490347
DOI: 10.1016/j.jcms.2024.10.004

Abstract

This retrospective study aimed to investigate the impact of orthognathic surgery with maxillary advancement (MA) on the velopharyngeal function (VF) in individuals with cleft lip and palate (CLP). The study included 651 patients with repaired CLP, both sexes, aged over 18 years who underwent MA alone or in combination with nasal procedures and/or mandibular osteotomy, operated between 2000 and 2019. The main outcome measures were nasalance (nasal text-NT and oral text-OT) and velopharyngeal orifice area measurement (VA), determined by nasometry and pressure-flow technique, respectively. Preoperatively, mean nasalance scores for NT and OT indicated normality, and VA demonstrated borderline-inadequate velopharyngeal closure in all patients. Following MA, a significant increase in nasalance scores for NT and OT occurred (p < 0.001), revealing hypernasality in those undergoing MA combined with nasal procedure (MAN, N = 191), bimaxillary orthognathic surgery with nasal procedure (BON, N = 227) and bimaxillary orthognathic surgery (BO, N = 151). Conversely, nasalance scores remained within the normal range for those undergoing isolated maxillary advancement (IMA, N = 82). VA exhibited a significant increase leading to the classification of VF as inadequate in the BON and MAN groups. Overall, MA contributed to VF deterioration, resulting in the appearance of hypernasality and increased VA, particularly when combined with nasal procedures.

Keywords: Cleft palate; Maxillofacial procedure; Orthognathic surgery; Velopharyngeal insufficiency.