Velopharyngeal function change after two-jaw orthognathic surgery in patients with cleft: A study on 162 consecutive cases.

BACKGROUND: Orthognathic surgery (OGS) is a common intervention used to correct midfacial hypoplasia in patients with cleft. Previous studies have reported that LeFort I maxillary advancement may impact velopharyngeal function, but similar investigations focusing on two-jaw OGS have not been conducted.

METHODS: A total of 162 consecutive patients with cleft lip and palate who underwent two-jaw OGS between 2015 and 2020 were enrolled. Clinical data were collected, and preoperative and postoperative skeletal measurements were obtained from cephalometric images. Velopharyngeal function was evaluated using perceptual analysis and nasopharyngoscopy. A logistic regression model was employed for the risk factors associated with changes in velopharyngeal function.

RESULTS: After two-jaw OGS, 82.1% of patients showed no change in velopharyngeal function, while 3.7% experienced improvement and 14.2% exhibited worsening of function. In addition, the changes in velopharyngeal function were statistically significant comparing to the pre-OGS velopharyngeal status. A multivariable logistic regression revealed that the amount of maxillary advancement independently predicted the deterioration of post-OGS velopharyngeal function (odds ratio = 1.74, 95% confidence interval (CI) = 1.20-2.52, p = 0.004). The receiver operating characteristic curve based on maxillary advancement demonstrated good discrimination, with an area under the curve of 0.727 (95% CI = 0.62-0.83, p = 0.001). The Youden index was 4.27 mm.

CONCLUSION: Despite the risk of velopharyngeal function deterioration in patients with cleft palate undergoing OGS, some individuals have experienced improved function following two-jaw OGS. The extent of maxillary advancement has a negative impact on the velopharyngeal function.